Fam Pract Manag. 2008;15(4):42-43
Cindy Hughes is the AAFP's coding and compliance specialist and is a contributing editor to Family Practice Management. Author disclosure: nothing to disclose. These answers were reviewed by the FPM Coding & Documentation Review Panel, which includes Robert H. Bosl, MD, FAAFP; Marie Felger, CPC, CCS-P; Thomas A. Felger, MD, DABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Emily Hill, PA-C; Kent Moore; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC, MHA.
Tobacco cessation codes
What do I need to do to get paid for smoking and tobacco cessation education using codes 99406 and 99407? Are modifiers necessary? What are the documentation requirements?
Codes 99406 and 99407 replaced G0375 and G0376, which previously were used to report these services. You must document the following: The patient's tobacco use;The patient's conditions adversely affected by tobacco use or the therapeutic agent affected by tobacco use;The amount of time spent on tobacco cessation counseling and the context in which it was provided.The code should be selected based on the amount of time devoted to the counseling; use 99406 for 3 to 10 minutes or 99407 for more than 10 minutes. When providing these services on the same date as a significant, separately identifiable evaluation and management (E/M) service, append modifier 25 to the E/M service code. For additional information, a coding reference is provided online through AAFP's Ask and Act program at www.aafp.org/tobacco (click “Reimbursement/Payment” on the left side on the Web page).
Specimen transfer to lab
What code should we report for obtaining a blood specimen or culture in the office and preparing it for transfer to the lab?
Code 36415 may be reported for collection of venous blood by venipuncture, and code 36416 may be used for collection of capillary blood specimen (e.g., a finger or heel stick). You can report CPT code 99000, “Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory,” to represent the work and cost you incur preparing a specimen for transport (e.g., centrifuging, separating serum and labeling tubes). However, many payers do not allow separate payment for the services 99000 describes because they consider these services to be incidental to other services on the same date. Check with the health plans you contract with to learn their payment policies for this code.
Home health services
When I perform home health certification or recertification (codes G0180 and G0179), I document how much time I spend developing or reassessing the care plan, the patient's diagnosis and the treatment plan. For auditing purposes, do I also need to save a copy of the certification statement that I signed, or does the note in my electronic health record (EHR) suffice?
The documentation in your EHR may be enough for auditing purposes, but I recommend keeping a copy of any document that you sign and send out. This gives you more information to justify the services you provided, and it is a record of what was on the document when it left your office. If possible, scan the document into your EHR for more efficient filing. Note that documenting the time you spend on these services is not required.
Diagnosis code for prothrombin time testing
What is the correct diagnosis coding associated with in-office prothrombin time lab testing for a patient who is taking an anticoagulant?
Because the reason for the test is therapeutic drug monitoring, the primary diagnosis code would be V58.83, “Encounter for therapeutic drug monitoring.” ICD-9 instructs providers to use an additional code for any long-term (current) drug use, in this case V58.61, “Long-term (current) use of anticoagulants.” Related comorbid conditions may also be coded (such as V43.3 for a heart valve replaced by means other than transplant).
Hospital discharge when the patient dies
Can I bill a discharge code if the patient dies while in the hospital?
CPT allows the reporting of discharge services when the patient dies in the hospital. The Medicare National Coverage Determinations Manual states, “Reasonable and necessary medical services rendered up to and including pronouncement of death by a physician are covered diagnostic or therapeutic services.” Medicare requires that you provide a face-to-face service even if it is to pronounce the death.
Hepatitis test
If a patient is tested for hepatitis because of possible exposure during a needle stick one year ago, what is the appropriate diagnosis code?
In addition to reporting diagnosis code V73.99, which represents screening for unspecified viral disease, you might report V15.85, which identifies “Exposure to potentially hazardous body fluids.” Additionally, code E920.5 indicates the exposure was related to a hypodermic needle stick. It is important to include the date of the accident on the claim to identify that the injury is not current. If the injury were current, a code identifying the site of an open wound might also be reported (e.g., 883.0, “Open wound of finger(s); without mention of complication”).
Nebulizer supplies
Is it appropriate to bill for the tubing and/or disposable mouthpiece used for nebulizer treatments in the office?
Like sutures and bandages, these supplies are considered incidental to the physician's service and are not typically paid for in addition to the nebulizer treatments.
Editor's note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information.