Wednesday, March 2, 2011

You Cannot Separately Bill For Starting the IV

Recently, our surgeon carried out an emergency room consult and administered intravenous sedation to perform an incision and drainage of a perirectal abscess. So if I charge for the consult and the procedure, can I code for the IV sedation also?
Well you can only report an intravenous (IV) sedationLink in addition to an E/M and procedure under certain circumstances. Only a conscious sedation is reportable separately and even that is only in some instances.

If your surgeon carried out conscious sedation, you may be able to bill that with the right documentation and depending on exactly which I&D code you are using. Remember that any code that has the ‘target' symbol in CPT codes includes conscious sedation, which means that you cannot bill the service separately.

If the IV sedation you talked about was conscious sedation for allowable procedure such as 45005 (Incision and drainage of submucosal abscess, rectum), you'll require to document who was monitoring the patient during the case (name and credentials like John Doe, RN). You will also need to document what drug was used and how much as well as the patient's vitals prior to, during, and after the sedation. If you do not have the documentation, you cannot bill for the conscious sedation.

If you cannot bill conscious sedation, you are unlucky for the IV. Beginning an IV is a facility service in the ED; as such you cannot separately bill for starting the IV.


New Insurance Calls for New Verification


A patient has received new coverage but hasn't received an insurance identification card as yet. How should you file a claim on a patient who has new coverage?

Preferably, when patients call to make appointments you should have someone in your office corroborate their insurance coverage and eligibility, more so if you know the patient is going to have new insurance.

The start of the year is the time when benefits verification tends to be most useful. While verification is good practice all year long, January is the time when you will see more insurance charges – including payer, benefit, and deductible/copay changes than at any other time during the year as most employers hold open enrollment in December.

Finding out about insurance changes before the appointment gives you time to check if you're a participating provider with the payer and verify coverage. If the patient does not have an identification number with her new insurance company, ask for the name of the insurer and the policy number from the patient or from the patient's employer. After this, call the insurer and verify the coverage and the date of eligibility, and get the proper information to identify the patient on your claim.

Note of caution: The date of eligibility is an important question to ask the payer as many employees do not make health insurance coverage immediately available to new workers. A patient with a new job and new insurance may be in your office for a visit; however his insurance is not effective for two months.

Option: Even though verifying coverage beforehand is the way to go, many practices have patients corroborate their insurance coverage and note any changes when they check in for their appointments. If you are not able to verify the insurance coverage, or you find the patient's not eligible for coverage on the day of the visit, inform the patient of the problem and ask if he wants to reschedule the appointment (unless it is an emergency visit). Or else, explain to the patient that the visit and services may not be covered, and that he must pay the bill himself. Have the patient sign a waiver stating that the services rendered that day may not be covered by the new insurance, and that he's responsible financially. You should keep the signed waiver in the patient record.



Tuesday, March 1, 2011

What Diagnosis Code to Use While Billing Medicare For Hiv Screening


If you are confused about which ICD-9 code to use while billing Medicare for HIV screening, read on and get to know the right answer:

Various diagnosis codes would be right here, depending on the patient circumstances. For all Medicare HIV screening billing, you should go for an ICD-9 "V" code as opposed to a code for signs or symptoms of disease.

If the screening is for a patient with no increased risk factors or medical complications such as pregnancy, you should report V73.89 (Special screening for other specified viral diseases).

If the patient reports increased risk factors such as past or present injection drug use, you should list V73.89 as the primary code and additionally report V69.8 (Other problems related to lifestyle) as the secondary diagnosis.

If the patient is pregnant, you can go for an HIV screening at three specific times associated with the pregnancy: when the pregnancy diagnosis is known during the third trimester, and at labor. For these HIV tests screenings during pregnancy, you should go for V73.89; in addition you should choose the proper ICD-9 code from the following list based on the specific patient situation:




  • V22.0 -- Supervision of normal first pregnancy
  • V22.1 -- Supervision of other normal pregnancy
  • V23.9 -- Supervision of unspecified high-risk pregnancy.

    Reporting one of these codes as a secondary diagnosis will allow you to bypass the HIV screening frequency restriction of once a year.

  • Ankle Fractures & Multiple X-Rays


    Scenario: A new patient presents to the office suffering from an injured left ankle she hurt while shoveling snow. The orthopedist carries out a detailed history and examination. Thinking it to be a fracture, the orthopedist orders a two-view ankle x-ray, which shows a bimalleolar fracture. The NPP provides local anesthesia and the surgeon uses closed treatment to manipulate the fracture. In order to ensure proper alignment, the orthopedist orders a second two-view ankle x-ray. Notes point to moderate medical decision making. The orthopedist writes the proper prescriptions, the NPP casts the ankle and the patient goes home. So in this scenario, can I code both ankle x-rays?

    Well, since the orthopedist orders separate x-rays for different purposes (identifying the fracture, ensuring proper bone placement), you can code for both. You should report the following on the claim:

    27810 (Closed treatment of bimalleolar ankle fracture [example, lateral & medial malleoli; or lateral & posterior malleoli or medial & posterior malleoli]; with manipulation) for the fracture care


  • 73600 (Radiologic examination, ankle; 2 views) x 2 for the x-rays (one prior to the surgery, and one to make ensure proper bone placement post-surgery)
  • 824.4 (Fracture of ankle; bimalleolar, closed) added to 27810, 99204 and 73600 to represent the patient’s ankle fracture
  • E016.0 (Activities involving property and land maintenance, building and construction; digging, shoveling and raking) added to 27810, 99204 and 73600 to represent the cause of the patient’s ankle fracture.

    See to it that you check with your payer update prior to filling this claim. Some payers might require you to place a modifier such as 51 (Multiple procedures) or 59 (Distinct procedural service) to the second x-ray code.

    For more on this and for other medical coding updates, sign up for a one-stop medical coding guide like Supercoder.com