Fam Pract Manag. 2008;15(5):38-39
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.
Stress tests
Can I be paid for both supervision of a stress test conducted at the hospital and interpreting and reporting the results? Does the hospital bill facility charges under a different code?
Yes. You should bill for these services using codes 93016 (for physician supervision only, without interpretation and report) and 93018 (interpretation and report only), and the facility may report code 93017 (tracing only, without interpretation and report) for the technical portion of the service. Code 93015 (“Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ECG monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report”) includes both the professional and technical components and is used for reporting the procedure in a non-facility setting, for example, where the physician owns the equipment, employs the staff and provides the supervision, interpretation and report.
Reviewing old records
In the medical decision making section of Medicare's Documentation Guidelines for Evaluation and Management Services, does the review and summarization of old records pertain to records of other physicians as well as the physician's own records? When choosing the level of service, would the physician get “credit” for reviewing records he or she generated in the past?
No, the guideline refers only to obtaining and reviewing records generated by others. The idea is that this type of review indicates that the nature of the patient's problem is more complex than would be suggested by the typical review of the patient's current medical record alone. Reviewing and updating the patient's past, family or social history or past review of systems as documented in your own record is credited toward the level of history obtained and thus toward the overall level of service.
Skin tag removal
I'm having a difficult time getting insurance companies to pay for skin tag removal. I use 11200 (plus 11201 if needed) with ICD-9 code 701.9. Any ideas on why my claims are being denied?
Prior to removing skin tags, you should determine the medical necessity of the removal and the payer's policy. Many health plans will pay for removal only if the skin tag is in an area that might be irritated by clothing such as a waistband or bra strap, causing bleeding or inflammation, or if it is blocking an orifice or obstructing vision. Other plans do not cover the procedure at all. If the procedure is for cosmetic purposes, the patient will likely need to pay out-of-pocket at the time of service. If a claim is submitted in this case, an ICD-9 code such as V50.8, “Elective surgery for purposes other than remedying health states, unspecified,” may be used. If a medical indication for removal is present, be sure to indicate so on the claim (e.g., 782.0, “Disturbance of skin sensation”). Otherwise, the codes you have indicated are appropriate.
Sports physicals
Is it OK to bill 97005, “Athletic training evaluation,” for a sports physical? If not, under what circumstances is that code allowable?
Code 97005 represents the services of an athletic trainer or therapist working within the scope of state licensure and a physician's order to evaluate a patient's ability to resume athletic activities following an injury and, if appropriate, to develop a care plan for athletic training. A sports physical may be reported with a code from the 99381-99397 series when provided in the context of an appropriate preventive medicine service. When this is not the case, use code 99499, “Unlisted evaluation and management (E/M) service,” or use an office or other outpatient E/M service code. Check with your payers to determine their policies. For more information, see “Sports Physicals: A Coding Conundrum,” FPM, October 2006.
Diagnosis coding for anticoagulation therapy
What ICD-9 codes should I use as secondary codes for anticoagulation therapy provided to a patient with a prosthetic heart valve who does not have atrial fibrillation? Our biller tells me that using only V43.3, the ICD-9 code for prosthetic heart valve, is inadequate.
Use V58.83, “Encounter for therapeutic drug monitoring,” for the primary diagnosis followed by V58.61, “Long-term current use of anticoagulants,” and V43.3 for the heart valve. Codes V58.61 and V43.3 are designated for use as secondary diagnosis codes only.
ICD-9 coding for palliative care
I am a family physician employed by an oncology group to provide palliative care services to their cancer patients. I practice in their office, and we share the same taxpayer ID code. Often an oncologist will identify an unmanaged symptom such as pain or mood problems and ask me to see the patient on the same day. When I document and code the visit, I use ICD-9 codes that describe the patient's symptoms and V66.7, “Encounter for palliative care.” The business manager tells me that this approach doesn't work and one of the claims will be rejected (usually mine). Is this correct?
Because your specialty is different than the oncologists in your group, your claims for treating patients on the same date should not be denied. With regard to diagnosis coding of your claims, ICD-9 guidelines indicate that you should include the code for the underlying disease before coding the V66.7 palliative care code. In other words, you should code the symptoms you are managing, then the cancer and finally the palliative care.
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.