Title: NP Office Coding
1NP Office Coding
STUMPERS (aka jeopardy)
- On loan from
- Allen Daugird, MD, MBA
- UNC Dept of Family Medicine
- May 2003
2Coding STUMPERS!
Paid for Thinking
Using Your Hands
Whats in a Name?
Prevention Counts
Grab Bag
3STUMPERS!
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5E M Codes
6What are Evaluation and Management Codes for
office visits?
- Used for cognitive services -i.e. most of our
office visits
7History, PE, Medical Decision Making
8What 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
9Patient who has never been seen in your office or
the last time was longer than 3 years ago
10What is a new patient?
- This is crucial in deciding which set of EM
codes to use - Reimbursement higher for new codes
a6a
1135 minutes of total of 40 minutes of office visit
for established patient used in counseling
12What 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
13CPT Code for Brief HPI, 5 organ systems PE,
moderate complexity decision making in an
established patient
14What 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
15Freezing warts, injecting trigger points,
excising moles
16What are office procedures?
- Almost anything you do with your hands (vs. your
brain) has a separate CPT code
17Code for Ear Wax Removal
18What 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)
19Code you use when providing both separately
identifiable EM service AND a procedure
20What 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
21Simple surgical procedures which do not have a
global period and for which you DO charge for any
post-op visits
22What 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
23CPT Codes you would use for giving 100mg
meperidine IM
24What are 90782 AND J2175
- When giving injections remember to charge for the
supply of the drug itself (J codes)
25ICD-9 Codes
26What 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
27Thousands and Thousands
28How 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)
29Writing down 250 as shorthand for diabetes code
250.00
30What is inadequate diagnosis coding?
- Have to code ICD9 codes down to all available
digits - Codes can be 3, 4, or 5 digits
31Diagnosis codes used for prevention, screening,
contraception
32What 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!)
33Diagnosis you would use for patient with nausea
but no vomiting when the cause is not yet clear
34What 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
35CPT Codes 99381-99397
d2
36What 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
37V70.0
38What 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)
39Daily Double
40HealthCheck
41What 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
42A Medicare patient who comes in with no medical
problems and just wants a physical
43What 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
44The 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
45What 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)
46A CPT code AND an ICD9 code
47What are needed for every encounter form
- Insurance company computers will reject claims
without both
48An ICD9 Code that supports each CPT code
49What 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)
50Billing for NP services under a physician name
and provider ID
51What 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
52An EM code physician/NP/CNM should never use
53What 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
54CPT codes used for an established patient whom
you evaluate for abdominal pain (Detailed Hx
PE) and also do anoscopy on
55What 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
56Final Stumpers!
Make a Wager
57Final Stumpers Answer
58What modifier is used when multiple procedures
are done on the same day
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