Journal of Urgent Care Medicine

Rule Number One: Code for Services Rendered

DAVID STERN, MD (Practice Velocity) Q.Which CPT codes can be used for diagnosis codes 786.50 (unspecified chest pain) and 414.9 (chronicischemic heart disease-unspecified) to maximize a Medicare patient bill? A.The basic rule of coding is that you should code for the services rendered, not to “maximize a patient bill.” In other words, you should code the best codes that indicate the actual services that were performed. For these codes, you could code for a cardiac …

Medical Necessity in E/M Coding, Part 3: Correctly Coding the Physical Exam

DAVID STERN, MD (Practice Velocity) Some coding auditors do not understand the urgent care setting. As a result, they have been inappropriately downcoding evaluation and management (E/M) levels— not based on levels of documentation, but rather on whether the documentation is supported by their “view” of medical necessity, even though these auditors have usually never been providers and lack clinical experience. In this situation, the best defense is a strong offense. This column reviews medical …

Can an Urgent Care Use an ED E/M Code and Three Other Coding Challenges

DAVID STERN, MD (Practice Velocity) Q.Can 99283 and 99214 procedure codes be used for an urgent care visit? The codes were used by an urgent care facility, and I am told that 99283 is categorized as an emergency room code. A.Code 99283 is for an emergency department visit for the evaluation and management of a new or established patient with an expanded problem focused history and examination and medical decision making of moderate complexity. Code 99214 …

Medical Necessity in E/M Coding, Part 2: ROS and PFSH

DAVID STERN, MD (Practice Velocity) Last month, we presented definitions for medical necessity offered by the AMA and the Centers for Medicare & Medicaid Services (CMS). We looked at the elements appropriate to perform and document in the History of Present Illness (HPI). And we briefly discussed Recovery Audit Contractors (RAC) audits. (If you missed it, the column is archived on the JUCM website [https://www.jucm.com] in the May 2011 issue.) This month, our focus is …

Medical Necessity in E/M Coding

DAVID STERN, MD (Practice Velocity) Q.Recently some of my charts were audited and the payor challenged the levels of the evaluation and management (E/M) codes I had used. The payor said that the charts were actually coded correctly, based on the information that was documented on the chart. The auditor, however, challenged what she called the “medical necessity” of the documentation. She claimed that, based on the patients’ chief complaints, many elements of the E/M …

S9088 Coding for Medicare or Medicaid, Coding for SVT, and Coding 99211

DAVID STERN, MD (Practice Velocity) Q.In one of your articles concerning the S9088 code (services provided in an urgent care center), you indicate this code cannot be billed to Medicare or Medicaid. However, I read in another source that S9088 and S9083 (global fee for urgent care centers) had been approved by the Centers for Medicare and Medicaid Services (CMS) for billing these services. What is the current status of these codes as they relate …

Coding Concerns: Versajet Debridement, Time Frame for New/Established Patients, Detailed Exams, Denial of S9088, –57 Modifier, and Billing for Injections

DAVID STERN, MD (Practice Velocity) Q.How do I code when using Versajet to debride an ulcer? A.For Versajet debridement, you should report CPT code 97597 (removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or …

Coding for Intravenous Infusion, Fees for S9083, Morgan Lens Irrigation, and UB-04 Revenue Codes for Urgent Care

DAVID STERN, MD (Practice Velocity) Q.I had a patient come in who needed IV fluids and monitoring for five hours. We found the CPT codes 96360 (intravenous infusion, hydration; initial 31 minutes to 1 hour) and 96361 (each additional hour…) to use for the IV hydration therapy. However, my doctor cannot believe how low these codes are reimbursed by his health insurance. We did bill an office visit in addition to the IV. Is this …

Coding for Complicated or Multiple I&Ds, Head CT, and Follow-ups— and When to Use CPT 99051

DAVID STERN, MD (Practice Velocity) Q. I notice that the code for complicated or multiple incision and drainage (I&D) procedures almost twice the reimbursement as the superficial I&D code. When can I code the code 10061 (Incision and drainage of abscess, e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia; complicated or multiple)? Anonymous A. The concept of multiple (i.e., more than one) is straightforward. The concept of complicated I&D is less …

‘Destruction’ Codes, Global Periods, Working with Provider Representatives, and Denial of G0431-QW

DAVID STERN, MD (Practice Velocity) Q. Our physician did a shave excision and sent it to pathology. It came back as malignant. She now wants to bill using the destruction codes of 17260-17286. We coders are trying to tell her that she needs to bill for the shave excision, because she documented clearly that she performed shave excision. What is the correct way to bill for this procedure? Name withheld A. Per CPT Assistant 2009: …