Addressing Problem-based Coding and Other Challenges

Q.We are a fairly new urgent care center and could use some help on E/M coding. I have read on various urgent care websites that we can bill each visit as a new patient visit (as long as it isn’t a follow-up to an existing problem). Can you please give me some direction on where I can find this information? A.What you are referring to is “problem-based coding.” Never code in this way unless you …

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Proper Coding for Removal of Foreign Bodies

Q.Recently we removed a tampon that was retained for one week. What is the code for removing a foreign body from the vagina? A.Although this procedure involves significant work, and the resultant foul odor can leave an exam room unusable for hours, the procedure is considered to be a part of the E/M. Of course, this is hard to understand, since there is a code for removing a foreign body from the external ear canal …

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Coding for Removal of Impacted Cerumen (69210)

Q.What is the correct use of CPT code 69210 (removal impacted cerumen [separate procedure], one or both ears)? – Question submitted by Kathy Partenheimer, Medical of Dubois A.In the July 2005 issue of CPT Assistant, the AMA clearly indicates that you should report 69210 onlywhen the following two criteria are both met: “the patient had cerumen impaction” “the removal required physician work using at least an otoscope and instrumentation rather than simple lavage” [emphasis added]. …

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Code Compliantly But Differently, Based on the Payor

DAVID STERN, MD (Practice Velocity) Q.I have been told that I can get credit for a complete review of systems (at least 10 systems) by simply noting positive findings in certain systems and then noting “all other systems negative.” A.This is, indeed, a general CMS “guideline,” but two Medicare carriers have issued contradictory guidelines. TrailBlazer Health Enterprises (Medicare carrier for Delaware, the District of Columbia, Maryland, Virginia, and Texas) and Wisconsin Physicians Services (Medicare carrier …

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