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NP Office Coding

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usually best if E&M services are for different diagnosis than procedure ... You can find a diagnosis code for most everything by using the list on pp 5-6 ... – PowerPoint PPT presentation

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Title: NP Office Coding


1
NP Office Coding
STUMPERS (aka jeopardy)
  • On loan from
  • Allen Daugird, MD, MBA
  • UNC Dept of Family Medicine
  • May 2003

2
Coding STUMPERS!
Paid for Thinking
Using Your Hands
Whats in a Name?
Prevention Counts
Grab Bag
3
STUMPERS!
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(No Transcript)
5
E M Codes
6
What are Evaluation and Management Codes for
office visits?
  • Used for cognitive services -i.e. most of our
    office visits

7
History, PE, Medical Decision Making
8
What are the three major components of EM
services?
  • Look at the grids (pp 2-3) at the front of your
    handouts
  • These major components determine the level of the
    EM CPT code

9
Patient who has never been seen in your office or
the last time was longer than 3 years ago
10
What is a new patient?
  • This is crucial in deciding which set of EM
    codes to use
  • Reimbursement higher for new codes

a6a
11
35 minutes of total of 40 minutes of office visit
for established patient used in counseling
12
What is a 99215 visit?
  • When more than 50 of EM visit is for face to
    face counseling or coordination of care, time can
    be the primary determinant of the code
  • Have to document the time (note just like in the
    Jeopardy question) in the along with a
    description of the issues counseling was about
  • See times in far right column of grids
  • CANNOT use for MCR incident to billing

13
CPT Code for Brief HPI, 5 organ systems PE,
moderate complexity decision making in an
established patient
14
What is a 99214 office visit?
  • Only need 2 of the 3 major components to support
    the EM code level for established patients
  • BUT need 3 of 3 for new patient codes

a10a
15
Freezing warts, injecting trigger points,
excising moles
16
What are office procedures?
  • Almost anything you do with your hands (vs. your
    brain) has a separate CPT code

17
Code for Ear Wax Removal
18
What is CPT code 69210?
  • Almost anything you do with your hands (vs. your
    brain) has a separate CPT code
  • Even though the office nurses usually do this, we
    can still bill for it (it is done incident to
    your services and under your supervision)

19
Code you use when providing both separately
identifiable EM service AND a procedure
20
What is Modifier -25 at end of EM code?
  • you have to have documentation for both the EM
    code and the procedure
  • usually best if EM services are for different
    diagnosis than procedure
  • YOU must circle the -25 modifier on the
    encounter form

21
Simple surgical procedures which do not have a
global period and for which you DO charge for any
post-op visits
22
What are starred procedures?
  • See description at beginning of Surgery section
    of CPT book
  • Can charge for separate EM services if provided
    (use 25 modifier)

b8a
23
CPT Codes you would use for giving 100mg
meperidine IM
24
What are 90782 AND J2175
  • When giving injections remember to charge for the
    supply of the drug itself (J codes)

25
ICD-9 Codes
26
What set of codes is used for diagnoses?
  • International Classification of Diseases, 9th
    revision, Clinical Modification
  • Adopted by HCFA, changes yearly
  • Major new version in the works
  • See primary care short list pp 5-6

27
Thousands and Thousands
28
How many ICD9 codesare there?
  • The book is thick
  • Organized by Organ System
  • May start in index, but need to read the actual
    table for exclusions, etc
  • You can find a diagnosis code for most everything
    by using the list on pp 5-6 (Available at
    www.aafp.org and updated annually in Oct)

29
Writing down 250 as shorthand for diabetes code
250.00
30
What is inadequate diagnosis coding?
  • Have to code ICD9 codes down to all available
    digits
  • Codes can be 3, 4, or 5 digits

31
Diagnosis codes used for prevention, screening,
contraception
32
What are V codes?
  • Whole list of V codes to describe non-illness
    situations
  • Many insurers will not pay for services when only
    these codes are used (including Medicare!)

33
Diagnosis you would use for patient with nausea
but no vomiting when the cause is not yet clear
34
What is 787.02?
  • There are a whole set of symptom ICD9 codes you
    can use when the diagnosis is not yet clear
  • Very helpful in primary care for initial
    presenting complaints
  • Beware of negative impact on patients
    insurability if you use disease diagnosis code
    (vs. symptom) that turns out to be wrong

35
CPT Codes 99381-99397
d2
36
What are the prevention CPT codes?
  • Age grouped codes
  • Medicare will NOT pay for these (MCR HMOs might)
  • NC State Employees Health Plan you must use
    these and V70.0 ICD9 code for the deductible to
    be waived
  • Comprehensive Hx, Comp PE (lt than in other
    EMs), counseling, lab

37
V70.0
38
What is the diagnosis code used for adult
wellness exams?
  • May also use v72.3 for gyn exam, v25.01 for oral
    contraception, etc
  • Use V76.2 for MCR screening breast/pelvic exam
    (special screening for malignant neoplasms,
    cervix)

39
Daily Double
  • Make a Wager

40
HealthCheck
41
What is the Well Child Check visit program for NC
Medicaid?
  • Medicaid has its own set of special codes and
    rules
  • Rules are complex, and may want to consider using
    a special encounter form
  • Reimbursement is excellent and worth the hassle

42
A Medicare patient who comes in with no medical
problems and just wants a physical
43
What is an uncovered service under Medicare?
  • Uncovered services do not need a waiver form
    signed, but you should discuss w/ the patient
    BEFORE providing services and see if they agree
    to pay themselves (pp 15-16)
  • In reality this is unusual for most Medicare
    patients-they usually have some symptoms or
    illness (remember menopause, osteoarthritis, etc)
  • MCR will pay for breast/pelvic exam q 2y

44
The CPT code type you would use for a woman
coming in for a Pap, but who has new complaints
of severe headaches and chest pain, which you
evaluate treat
45
What is an office visit EM code
  • Prevention codes do not cover significant medical
    problems
  • You can use both a prevention code and EM code
    with modifier 25, but usually an EM code is used
    (would have to have documentation to support both)

46
A CPT code AND an ICD9 code
47
What are needed for every encounter form
  • Insurance company computers will reject claims
    without both

48
An ICD9 Code that supports each CPT code
49
What is needed for every encounter form
  • Insurance claims are submitted electronically
  • Its one computer talking to another
  • A CPT code will not get paid unless there is a
    diagnosis code supporting it (i.e. the insurance
    computer has logic that will only pay for the CPT
    code if it finds certain ICD9 codes that it
    thinks justify it)

50
Billing for NP services under a physician name
and provider ID
51
What is incident to billing?
  • The way most commercial insurance is billed for
    NP services
  • An option for MCR MCD, but have to follow their
    rules for incident to (pp 10-13)
  • NPs can bill MCR/MCD directly, but will get only
    85 of MCR fee

52
An EM code physician/NP/CNM should never use
53
What is a 99211?
  • This almost always is for nursing only visits
  • Look at the grid for 99212 almost any clinician
    encounter will fulfill the criteria

54
CPT codes used for an established patient whom
you evaluate for abdominal pain (Detailed Hx
PE) and also do anoscopy on
55
What are 99214-25 AND 46600?
  • Need only 2 of 3 components for established
    patient EM codes
  • Use -25 modifier after CPT code to tell insurer
    you did EM service separately in addition to
    procedure

56
Final Stumpers!
Make a Wager
57
Final Stumpers Answer
  • modifier -51

58
What modifier is used when multiple procedures
are done on the same day
59
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