Coder's Cranium / General / Hot Coding Topics / Provider News

4 Amazing Ways to Code for ‘Get Acquainted’ Visits

Do you ever meet with parents before their baby is even born?  In these cases, you might be hesitant to charge for the visits because the patient isn’t present yet—but can you collect anything for the physician’s time?  Check out the following 4 options, along with our expert advice before billing to insurance.

1. Consider an Office Visit

Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201.  However, this would need to be billed based on time to the mother’s insurance company and would likely be questioned by the insurance company.  For practices that do charge for these services, there’s a diagnosis code you can use: V65.11. ICD-9 guidelines allow you to list the code as a first or additional diagnosis.

2. Ensure You Meet Criteria Before Using 99401-99404

As an alternative to use a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem an appropriate counseling or risk factor reduction code.  You may report these codes for prenatal counseling “if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e., seeking advice to avoid a future problem or complication),” according to the AAP’s Coding for Pediatrics 2009.

You would report the service under the mother’s insurance, according to the AAP. Make sure you don’t use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness.  As per CPT®’s Counseling Risk Factor Reduction and Behavior Change Intervention guidelines, “these codes are used to report services for the purpose of promoting health and preventing illness or injury.”

Codes 99401-99404 aren’t necessarily shoo-ins for typical meet and greets.  The AAP gives...

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June 8, 2011
CPT 2011 / Hot Coding Topics / Provider News

Look Up New Observation Codes When Reporting ‘Middle Days’

2011 brings a new coding option when reporting the middle day of observations that last longer than two days. Check out this expert advice on how CPT additions will affect your FP’s observation care services coding starting on Jan. 1, 2011.

Until this point, coding for the “middle days” of an observation service caused problems. Although not the norm, there are times when a physician admits a patient to observation and she remains in that status for three or more days. CPT 2011 addresses these middle days between admission and discharge by introducing three new E/M codes. The additions parallel the hospital subsequent care series in terms of component requirements and time frames:

  • 99224 – Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99225 — … an expanded problem focused interval history; an expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/ or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.
  • 99226 — … a detailed interval history; a detailed examination; Medical decision making of high complexity. Counseling and/or

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February 6, 2011
Hot Coding Topics

Simplify Ear Coding With These Expert Tips

With more patients turning in for a variety of ear conditions, you cannot afford to lose any reimbursement. Look to our expert advice to ensure you’re coding correctly for all of the ear associated diagnoses.

1. Verify Documentation for E/M With 69210

Cerumen removal can present several coding challenges for your practice, particularly if the physician performs the service as a gateway to visualize the ear. Knowing when you can report 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) is key to collecting for this service.

Example: Suppose a patient presents with ear pain, but the physician has to remove impacted cerumen before he can visualize the tympanic membrane. He subsequently diagnoses an ear infection. Your practice wants to bill an office visit and modifier along with 69210 – is that acceptable?

Key: “Whether to report 69210 is always a value judgment because if you just flick a little wax aside to visualize the eardrum, you shouldn’t bill for cerumen removal,” says Charles Scott, MD, FAAP, with Advocare Medford Pediatric and Adolescent Medicine in New Jersey. “Typically, I’ll use that code if I have to use a special device that allows me to curette the ear before I can visualize the tympanic membrane,” he advises.

The July 2005 CPT Assistant states that cerumen is considered “impacted” in several circumstances, one of which is, “cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.” Therefore, if the cerumen is blocking the physician’s view and he has to use special instrumentation to remove it above and beyond irrigation, most payers allow you to report 69210.

You should ensure that you have separate documentation of the E/M service and procedure to support reporting both codes. Some practices overuse 69210, which means many...

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December 15, 2010
ICD-10 / Toolkit

ICD-10: Catch a Glimpse of Diagnoses Changes for Hematuria BPH, and More

Get used to using letters in your diagnosis coding. Take a look at some of the ways your urology diagnosis coding will change in 2013 by reviewing this chart of some common diagnoses you see in your urology practice. This rundown, based on the ICD-10 2...

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November 14, 2010
Hot Coding Topics / modifier 22

Give Your Radiosurgery or Gamma Knife Surgery Coding a Check-Up

Improve your reimbursement chances by applying modifier 58 in this situation. When your surgeon targets the brain or spine with stereotactic radiosurgery (also called gamma knife surgery) to treat multiple lesions over multiple sessions, you need to know two crucial things: what stereotactic radiosurgery codes to use and how many units to include. Take this three-question challenge [...] Related articles:

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February 28, 2010