Coding

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Coding BillingAncillary Services

• Cheryl Slayden
• Mary Etchison, CCS, CCS-P

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Coding
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Definitions

• Ancillary Services- Professional services such
  as lab and radiology
• Non-M.D. - Nursing, Nutrition Therapist, and
  others

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Nursing Services

• Nursing visit in conjunction with a provider
  visit
• Nursing visits as a separate clinic

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Nursing Visits

• When a nurse visit is part of a provider visit no
  separate EM
• Code procedures that were done
• Some nurse documentation can be factored into the
  provider EM code
• Certain things are never coded separately

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Nurse Run Clinics

• Some services provided by Nurse only
• Every encounter must have a primary diagnosis
• Include all diagnoses that impact care
• Used as a measure of patient severity
• Paints a clearer picture of the patient
• Remember-Every code assigned follows the pt. for
  Life

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Nurse Run Clinics

• V codes may be used for certain visits (e.g.
  Coumadin Clinic)
• Never use an acute code for a residual diagnosis
  (e.g. Acute CVA)
• If no established diagnosis code signs symptoms

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Nurse Injections

• InjectionsCode both the injection the material
  being injected
• Update encounter forms to ensure all codes are
  current, including drug codes
• Use the 951XX series when nurse gives an allergy
  shot

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Nursing Clinic

• 99211 is the ONLY EM code available for nursing
  use
• Certain procedure codes may be used by nursing
• Certain Educational codes may be used by nursing

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Laboratory and Pathology

• Lab panels must be coded as a panel
• Use diagnosis for DOS labs were ordered
• CIDC will help with lab diagnosis
• Pathology and Cytopathology services are coded
  for both I/P O/P professional services.

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Laboratory and Pathology

• Professional services follow O/P coding
  guidelines
• Code the physician interpretation for O/P
  professional I/P Services
• Abnormal results cannot be coded on the I/P stay
  without supporting documentation from the
  attending.

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Radiology

• Code findings
• If no definitive findings code signs symptoms
• Use Modifiers when needed

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Radiology

• What about workload?
• What to do if the codes in the radiology package
  is unbundled?

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PT/OT/ST

• CMS and Supplementals require modifiers
• -GP Physical Therapy
• -GO Occupational Therapy
• -GN Speech Therapy

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PT

• Hot/Cold Pack Modality code 97010 and
  Non-selective Debridement 97602 are ALWAYS
  bundled into other services
• Usually 97504 97116 are not billed together
  unless done on different extremities
• Dont forget the
  8 minute rule

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Nutrition Therapy

• V65.3 is the primary code for Nutrition therapy
  services
• Disease Diagnosis is secondary
• Codes 97802-97804 reflect MNT services
• G0270 G0271 are for reassessment of same pt.
  different diagnosis

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• Why are so many different services coded with
  99211?
• Workload capture vs. CPT Coding

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Billing
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Billing for Nursing Services

• When a nursing visit is part of the provider
  visit nursing services are not billable
• E/M services provided by nursing are billed on a
  UB-92
• LPNs are allowed to use E/M code 99211 and can be
  billed on a UB-92
• Patients seen by nursing at a health fair are not
  billable

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NURSING SERVICES (cont)

• Blood transfusions provided by nursing are
  billable on a UB92
• Interviews conducted, by nursing, for SATP
  Program are billable on a UB92 using 99211

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NURSING SERVICES (cont)

• Flu / Pneumonia vaccines are covered by Medicare
  at 100. They are not billable to Medicare
  supplements
• Nursing injections of patient supplied
  medications are billed using 90782

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Laboratory / Pathology Billing

• Integrated Billing Package defaults to the UB92
  for initial bill creation
• Pathology rates can consist of Technical and
  Professional components

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Medicare Coverage

• Laboratory services are generally covered at 100
• Medicare supplemental policies should not be
  billed
• Certain Lab/Path services are only paid, by
  Medicare, at 80. Medicare supplements can be
  billed for these services. This list is
  available from the Laboratory/Pathology Fact Sheet

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Reference Labs

• Lab work completed at contract reference labs is
  billed by the hospital
• Non-contract reference labs would bill for the
  test

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Lab Panels

• Do not bill lab panels and then list the test
  individually
• CPT panels do not match VA lab panels

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Venipuncture G0001 and 36415

• Medicare would cover at 100. Supplements and
  secondary plans should not be billed
• Other commercial carriers may accept 36415
• When the same site is performing the lab test
  36415 should not be billed

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Radiology

• Radiology tests are not included as part of the
  global surgical period
• Pre-op radiology procedures for surgical
  treatment of SC conditions are considered SC and
  not billable
• Bilateral exams may require the use of LT and RT
  Modifiers
• Inpatient radiology exams are included in the
  DRG. Only pro fee bills should be completed

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PT/OT/ST

• These services are billed on a UB92
• Components of initial plan
• Diagnosis
• Type of therapy planned
• Frequency of service
• Duration of service
• Anticipated goals
• Physician order required must be signed and
  dated

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PT/OT/ST

• Plan required every
  30 days. Changes must
  be made in writing and signed
• Therapy not included in Global Surgical Period
• Inpatient services are not billed separately
• Carrier may require pre-authorization for these
  services

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Nutrition

• Inpatient dietician / nutrition services included
  in DRG
• Dieticians must be licensed and properly entered
  in the new person file
• Reimbursement dependent upon type of services
  covered
• Nutritionists are non-billable providers

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QA

• Website
• vaww.va.gov/cbo/rcbilling.html

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QA

• Website
• vaww1.va.gov/health/him/index.htm

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Questions/Comments/Concerns
Cheryl.Slayden_at_med.va.gov Mary.Etchison_at_mail.va.go
v Barbara.Millas_at_med.va.gov