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Top
5 Coding Questions
For the Week of September 3,2000
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| 1) |
Q. We
perform cardiac stress tests in the office and use 93015. We
also perform stress tests in other facilities so patients can
be given contrast material such as Thallium, and a cardiac scan
can be done. What code should we use for this?
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A. Answer:
Code 93015 (cardiovascular stress test using maximal or submaximal
treadmill or bicycle exercise, continuous electrocardiographic
monitoring, and/or pharmacological stress; with physician supervision;
with interpretation and report) is correct for office use. When
performed in a facility, the physician component of the cardiac
stress test is billed 93016 (physician supervision only, without
interpretation and report) and 93018 (interpretation and report
only). The facility bills 93017 (tracing only, without interpretation
and report). Myocardial imaging studies should be billed using
the 78460-78496 series, myocardial perfusion imaging codes,
with the physician who provides the service using modifier -26
(professional component). The facility will use the same code
with modifier -TC (technical component).
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| 2) |
Q. A
physician wants to teach a nutrition class to a group of 20
people one night per week. What is the code for this?
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A. Codes
99401-99404 (preventive medicine, individual counseling) and
99411-99412 (preventive medicine, group counseling) are all
preventive medicine counseling codes that are billed by the
amount of time the physician spends with the patient(s). If
a physician is teaching in a group setting and all individuals
are the receiving the same information and are not being taught
individually, 99078 (physician educational services rendered
to patients in a group setting [e.g., prenatal, obesity, or
diabetic instructions]) is appropriate.
Most insurance companies will need prior authorization before
you bill for these services. They may also limit the amount
of visits per patient contract.
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| 3) |
Q. What
is the charge and coding for the repair of a fiberglass cast
with the diagnosis of multiple fractures? The same doctor applied
the original cast two days earlier.
In addition, what is the proper coding for a fiberglass cast
vs. plaster cast?
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A. When
coding for a fiberglass cast repair, use the original casting
code (29000-29799) and indicate modifier -76 (repeat procedure
by same physician). Modifier -76 is used when a physician needs
to indicate a procedure or service was repeated subsequent to
the original procedure or service. Modifier -52 (reduced services)
should be used to indicate a reduction in service and fees.
This reduction in fees is based on the discretion of the physician
and usually consists of actual material costs of the reduced
procedure. Patient documentation should note the need for the
additional service and the actual determination of the cost
of the procedure.
There is no coding difference for the application of a fiberglass
or plaster cast. The same code would be used for both castings,
but billing for the supplies for the cast is different. HCPCS
code A4580 (cast supplies [e.g., plaster]) or A4590 (special
casting material [e.g., fiberglass]) should be billed. Dressings
applied by the physician are included as part of the professional
service and are subject to the local carrier. Check with the
insurance company to determine how casting is classified for
global period, or number of follow-up days.
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| 4) |
Q. We
provide psychiatric clinical services on a geriatric inpatient
psychiatry unit. Most of the patients suffer from dementia with
delirium or depression and have other medical diagnoses and
multiple prescription medications. We typically treat these
patients with antidepressant medications combined with anti-psychotic
medications or mood stabilizing medications (such as anticonvulsants).
Would it be likely that our inpatient rounding visits would
qualify for a 90862 coding?
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A. Code
90862 (pharmocologic management, including prescription, use,
and review of medication with no more than minimal medical psychotherapy)
is intended for use by the physician who is prescribing pharmacological
therapy for a patient with an organic brain syndrome or whose
diagnosis is in the range of 290.0-316 (senile dementia, uncomplicated)
and is being managed primarily by psychotropic and/or antipsychotic,
antidepressants, and/or other types of psychopharmacologic medications.
It also may be used for the patient whose psychotherapy is being
managed by another health professional, and the billing physician
is managing the psycho-pharmacologic medication.
Code 90862 includes prescribing medication, monitoring the effect
of medication and its side effects, and/or adjusting the doses.
Any psychotherapy provided is minimal and usually is supportive
only. Documentation of 90862 use should be in the patient record
(i.e., diagnosis, psychiatric medications, interval history,
mental status exam, assessment,
action taken and plan). The medical record must be made available
to Medicare upon request and claims should include the name
of the drug and the dosage (not all states require this so check
with your local carrier).
The following are questions and points to consider when using
90862:
1. Is this code payable in the inpatient setting?
2. Typically this code requires about 15 minutes of time.
3. 99231 (subsequent hospital care) might be a better choice
because it is used for recovering, stabilizing or improving
and would not be subject to a psychological reduction, which
the 90862 code is.
4. Look these codes up in the Medicare Fee Schedule and compare
the allowables.
5. Only minimal psychotherapy can be done to use this code,
so if patients require more than minimal time, then this code
cannot be used.
6. 90862 is used by the psychiatry profession mainly in the
clinic, outpatient, or nursing facility setting.
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| 5) |
Q. How
would I code for a laminectomy at T12, L1 and L2 (vertebrae
positions) for resection of an intradural tumor?
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A. The
codes for laminectomies of an intradural tumor are in the series
63275-63290 (laminectomy for excision of intraspinal lesion
other than neoplasm, intradural; cervical). The individual selection
is based on extradural or intradural or a combination of both.
Codes 63275-63290 also are categorized by level, whether cervical,
lumbar or thoracic. Choose one code to represent the level most
affected by the tumor. Unlike other spinal surgical codes, there
will be only one code for the entire procedure, rather than
a code for each spinal segment or spinal interspace.
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Source
Information: Susan
Callaway-Stradley, CPC, CSS-P, an independent coding consultant
and educator in North Augusta, S.C.; Brenda Dombkowski, RMA,
CPC, Senior Billing Specialist, Ob-Gyn & Infertility Group,
P.C., Woodbridge, Conn.;Renee Hilgert, Manager, Podiatry Claims,
San Antonio, TX; Linda Jackson, CCS-CPC, Medicare Consultant,
Iowa Veterans Home, MarshallTown, IA; Susan Callaway-Stradley,
CPC, CSS-P, an independent coding consultant and educator in
North Augusta, S.C.
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