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 clear. CPC Assistant is quite ambiguous, as it states: “The choice of code is at the physician’s discretion, based on the level of difficulty involved in the incision and drainage procedure.”

One indication that the code for complicated I&D is appropriate is that the fluid is being drained for tissues deeper than the epidermis, dermis, and subcutaneous tissue. Of course, it is important for the physician to document in the procedure note what deeper tissues are involved.

Q. I have a question about CT. If you do a CT of the head using the code 70450, does that code include the reading, or is there another we should bill for the interpretation of the scan?

Cheryl Kennedy
A. When you bill the code 70450, the code includes the reading of the study. Radiology codes include both the technical component (equipment and personnel involved in performing and preparing the study) and the professional component (physician reading of the study). If you bill the code without a modifier, then you are billing for both the technical and the professional component.

Radiology codes can be split into their separate components by adding modifier -TC to bill only for the technical component and by adding modifier -26 to bill only for the professional component (physician reading of the study).

Q. What is the appropriate code for an 18-month-old established patient that returns for a follow-up on acute suppurative otitis media with rupture of eardrum?

Marcie, West Bloomfield, MI
A. The concept of the follow-up visit is sometimes confusing. If the patient sees the provider for a routine follow-up visit during the global period for a procedure, then the code 99024 is the appropriate code. In the situation you bring up, however, there is no mention of a procedure, involving a global period, on the initial visit. Thus, assuming that the provider saw the patient for the follow-up visit, the provider should select the E/M code (99212-99215), based on the level performed and documented in the patient’s medical record.

We are hoping to could get your help answering a coding question. We have a day clinic with operating hours 8:00 a.m. – 1:00 p.m. by appointment only. The facility is considered a freestanding urgent care facility with operation hours of 1:00 pm – 8:00 pm. We know that we have to bill E/M CPT codes for the urgent care, but we are puzzled if we are allowed to use CPT 99051 after 5:00 pm.
Toni Gonzalez
In regard to 99051, this is not an urgent care specific code. The code may be used by any medical practice that provides regularly scheduled evening, weekend, and holiday hours.

Many payors may not reimburse for this code. Some payors may reimburse for this code, but only if the payor has the practice you envision enrolled as a true urgent care center.

It is important to note that your practice would not accept walk-in patients during all hours of operation. Thus, this practice does not meet the UCA criteria of a true urgent care center.

Note: CPT codes, descriptions, and other data only are copyright 2010, American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).

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

David Stern, MD

Chief Executive Officer at Experity, Previous Chief Executive Offer at Practice Velocity Urgent Care Solutions, Founding Member of the Urgent Care Association of America, Publishing Staff for The Journal of Urgent Care Medicine
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