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Ask The Coder™ Answers
Some Free Anwers to Coding Questions?
Disclaimer - Coding is based on general coding practices and in no way guarantees payment from any insurance carrier. Questions are topic specific and answers ONLY apply to the specific question asked.
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Q. Colon Screening: When we schedule a patient for a consult and the patient shows up for a screening colonoscopy what, if anything, can we bill for the office visit? Are we able to bill a 99402? The vitals are taken, patient history and systems are reviewed. The doctor is in with the patient to review all medications and to discuss the risks with the patient. What can and should we do?
Answer - Screening Endoscopy with E/M services: If the patient presents to be evaluated for coumadin management prior to the screening or with symptomatology that warrants an office visit then there can be a visit billed at the supported level of service.
Codes 99201 - 99205 or 99211 - 99215 should be used with a modifier -25 along with a distinct ICD-9-CM code to support the E/M service.
As for a consultation: The Medicare update to consultations (section 30.6.10) specifically states the following "...consultations are not to be coded for routine screenings...". A consultation would not be an appropriate code level since the referring physician is not asking for the doctors opinion or adive.
If the patient is not high risk or asymptomatice and a problem oriented visit does not exist, the AGA has decided that there is no visit (E/M value) to be billed. Their position is... there is no problem oriented visit that can be substantiated for a "pre-screening".
You should note that modifier -25 is highly audited and may flag your office. The E/M visit should only be used when there is a separate and distinct reason that would warrant the service and should not be used routinely for patients. If the physician is merely checking vitals and reviewing the informed consent there is no E/M visit afforded as it is considered an inclusive part of the procedure.
Q. What is the CPT code for removal of infected mesh when this is the only procedure performed? The mesh was originally placed for an inguinal hernia repair a couple years ago. Now it is infected and was removed. How do you correctly code this?
Answer - Typically we suggest using CPT® codes:
11004 ~ Debridement of skin for necrotizing soft tissue infection
and
+11008 ~ Removal of prosthetic material or mesh, abdominal wall
for necrotizing soft tissue infection
Since CPT® code +11008 is an add-on code it cannot be reported separately. In a situation where the only procedure performed was the removal of the infected mesh, we suggest using the unlisted code:
49999 ~ Unlisted procedure, abdomen, peritoneum and omentum
And add "removal of infected mesh seperate procedure" or "removal of infected mesh, late effect" in Box 19 of the HCFA / CMS 1500 form.
Q. What services are provided with dental code D9110 - palliative treatment for pain? We're not sure if you are asking what can be billed along with D9110 or how it is to be used so we'll explain both...
Answer - What can be billed along with D9110: Most carriers will only allow x-rays to be billed in conjunction with D9110 as this code is used to temporarily relieve a patient from pain.
How it is used: D9110 is used for emergency purposes only, to temporarily relieve a patient from pain. For Example: Patient presents with PA abscess, the dentist drills the tooth to relieve the pressure and removes the infection. Patient is then given a prescription for antibiotics and a pain killer. The patient is then scheduled in a couple of days for a root canal.
Q. What do we code for Morsicatio Buccarum?
Definition: Whitish, shredded appearance of the buccal or labial mucosa at the occlusal line caused by biting. The lesions are benign and the habit is most common in tense or anxious individuals
Synonyms & related keywords: frictional keratosis, oral friction keratosis, oral lesion, oral hyperkeratinization, chronic cheek biting, chronic lip biting, cheek bite keratosis, lip bite keratosis, morsicatio buccarum, oral ridge callus..
Answer - Most offices will use the following ICD-9-CM codes:
528.9 ~ Cheek & Lip biting
In addition to ONE of the following codes:
528.71 ~ Minimal keratinized residual ridge mucosa
528.72 ~ Excessive keratinized residual ridge mucosa
The difference depends on the severity of the problem.
Q. What is the HCPCS Modifier for more then one nursing visit on the same day? If you are using HCPCS codes and you are a Home Care facility what is the Modifier you would use if you had two skilled nursing visits to a patient on the same day so the second skilled nursing visit would not be denied as a duplicate charge.
Answer - Without knowing why the patient needed to be seen twice in one day the best answer is:
Use modifier -SC ~ medically necessary service or supply
Modifiers UF - UJ and append the appropriate modifier to each code
-UF ~ services provide in the morning
-UG ~ services provided in the afternoon
-UH ~ services provided in the evening
-UJ ~ services provided at night
For example if the patient was seen in the morning and then in the afternoon use modifiers UF & UG
Q. A Medicare patient receives 30 minutes of individual diabetes
out-patient, self-management training session, How will I code?
Answer - Use HCPCS code G0108 ~ diabetes outpatient self-management training services, individual, per 30 minutes
Modifiers may be needed with this code;
- -AE ~ training provided by a registered dietician
- -SW ~ training provided by a certified diabetic educator
You should note that this code is SNF (Skilled Nursing Facility) excluded.
Q. If the doctor does an EGD (upper gastrointestinal endoscopy) w/dilation and biopsy, can I bill both CPT® codes 43239 and 43249. If yes, do I need a modifier?
Answer - Yes, you can bill both CPT® codes:
43239 ~ EGD with biopsy, single or multiple and
43249 ~ EGD with dilation of esophagus (less than 30mm diameter).
A Modifier IS required for the following scenarios:
- -51 ~ same area
- -59 ~ different area
Q. Doctor did a colonoscopy but was unable to complete the procedure due to fecal impaction. What code should be used since the patient is rescheduled for another colonoscopy in 3 weeks and the insurance only allows one every 12 months?
Answer - An incomplete colonoscopy with inability to extend beyond the splenic flexure, due to poor preparation of the patient is billed using CPT® code 45378 ~ diagnostic colonoscopy
Since the procedure was incomplete you must append modifier
-53 ~ discontinued procedure
Please Note - An incomplete colonoscopy, with full preparation by the patient should have modifier -52 ~ reduced services appended to the claim instead..
In addition, you should consider adding ICD-9-CM code
V64.3 ~ procedure not carried out to the claim as well.
Q. Doctor is an Oral Surgeon and, the hospital referred a patient to the office for a mandible fracture.
We billed the dental insurance and received a denial because it was an accident. "The patient was hit in the face with a forklift."
Can we bill the patients medical insurance for this? If yes, how?
Answer - Yes, the patients medical insurance can be billed for the claim. Without knowing whether the fracture is open or closed, you have the following CPT® codes available;
- 21453 ~ closed fracture WITH interdental fixation
- 21462 ~ open fracture WITH interdental fixation
- 21461 ~ open fracture WITHOUT interdental fixation
In addition, your claim should include one of the following
ICD-9-CM diagnosis codes:
- CLOSED - 802.20 ~ unspecified mandible fracture, closed
- OPEN - 802.30 ~ unspecified mandible fracture, open
Please Note - Because the patient was hit in the face with a forklift you must add ICD-9-CM code E919.2 ~ struck by forklift, along with the appropriate fracture code.
CPT® is a Registered Trademark of the AMA.
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