Family practice coding: Which code for emphysema visit?

Here's a family practice coding scenario: When an established patient with emphysema presents complaining of shortness of breath, which CPT code should you go for? The physician provides inhalation treatment, teaches the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity.

Well, you'll require more than one CPT code for this encounter. Use 94640 to cover the all-encompassing service the physician provided.

Since the doctor also carried out an office visit, go for 99213 based on your documentation of an expanded problem-focused exam with low-complexity decision-making. You might require to add modifier 25 to 99213 to indicate that the evaluation & management service was significant and separately identifiable from 94640.

Go for 94640 in place of 94664 as the physician's main intent was to treat the obstruction.

A word of caution: If you bill 94664 with 94640 on the same day to Medicare, see to it that you justify that the doctor provided the 94664 service distinctly separate from the treatment. In this instance, add modifier 59 to 94664 to notify the payer that the FP carried out 94664 separate from 94640. The documentation should include details on the medical necessity for separately providing this service.

Here's an instance: The doctor determined that the patient's plan of care should include inhalation therapy or the patient is new to this therapy and doesn't know the administration techniques involved in the procedure. The note should clearly show that the doctor demonstrated the inhaler to the patient separate from the administration for treatment. Or else, the insurer may think you're trying to report one service twice.

Note: even though it's technically not required, it may link separate diagnosis codes to the E/M and the nebulizer treatment. Say for instance, you could link 786.05 to 99213, and link the emphysema code (492.8, Other emphysema) to 94640.

Family Practice Coding: Foot Claims Success Tips

So your anatomic terminology tripping up your foot and ankle claims? If so read on for more about some of the more common foot procedures your family physician might face and you will be coding those services like a pro.

You should build coding foundations with basic knowledge. Sudden impacts, say for instance those from jumping during sports) or simple wear-and-tear can lead to toe, foot and ankle problems. You should know the differences between these diagnoses or you may miss a subtle difference and report the wrong code.

Medical coding tip: You might need modifiers to help differentiate work on different areas of the feet or toes. These modifiers include LT, RT, TA-T9 and sometimes 59, depending on the service your physician provides. These modifiers become all the more important if the FP performs the same procedure on more than one foot or toe.

You should check differences between bunions and hallux valgus. A bunion happens to be an enlargement of bone or tissue around the metatarsophalangeal (MTP) joint of the great toe. It's often caused by patients wearing shoes that are too narrow around the toe box and can lead to pain and deformity of the toes.

You should verify injection rules for Morton's Neuroma, TTS

Morton's neuroma (355.6) is a thickening of the plantar nerve lying between the heads of the metatarsals. Normally, symptoms include pain, tingling, burning or numbness in the area. This can be caused by wearing shoes with a narrow toe or box or due to sports.

Doctors conduct a physical exam and many a time use x-rays to diagnose a Morton's neuroma. Rest, orthotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and changing shoes will normally help lessen the patient's pain, however corticosteroid injections may be necessary. In some instances, the family physician might refer the patient to a surgeon for excising the neuroma surgically.

Compression or entrapment of the posterior tibial nerve causes tarsal tunnel syndrome (TTS, 355.5). This condition is similar to carpal tunnel syndrome in the wrist, however causes pain and numbness at the bottom of the foot. Extreme standing on the feet, varicose veins, bone spurs, athletic injuries, and other issues can lead to tarsal tunnel syndrome.

Physicians depend on a physical exam to diagnose TTS, normally along with studies including electromyography (95860- 95872) or nerve conduction studies (95900-95905). Once the physician confirms the diagnosis, she'll usually begin conservative treatments such as injections, NSAIDs, rest, and footwear changes. However in some cases, the patient may need surgery. The most common surgical treatment happens to be a tarsal tunnel release (28035).

PTTD, Plantar Fasciitis may need surgery. Posterior tibial tendon dysfunction (PTTD) takes place when the posterior tibial tendon becomes inflamed, stretched out, or torn because of wear-and-tear or a sudden injury. Normally physicians can diagnose this condition using a physical exam, x-ray, or MRI.

Family Practice Coding: What Should You Report For Emphysema Visit

Code 94640 to cover the comprehensive service the physician provided.

An established patient with emphysema presents complaining of shortness of breath. The doctor provides inhalation treatment, trains the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision-making of low complexity. Considering this, which CPT code should you report here?

Well, one CPT code will not suffice. You will need more than CPT code for this encounter. You should use 94640 to cover the comprehensive service the physician provided. Since the physician also carried out an office visit, go for 99213 based on your documentation of an expanded problem-focused exam with low-complexity decision-making. You might be required to add modifier 25 to 99213 to indicate that the evaluation & management service was significant and separately identifiable from 94640.

You should use 94640 in place of 94664 since the physician's primary intent was to treat the obstruction.

Word of caution: If you bill 94664 along with 94640 on the same day to Medicare, see to it that you justify that the physician provided the 94664 service distinctly separate from the treatment. In this instance, add modifier 59 to 94664 to notify the payer that the family physician performed 94664 separate from 94640. The documentation should cover details on the medical necessity for separately providing this service.

Here's an instance: The physician determined that the patient's plan of care should cover inhalation therapy, or the patient is new to this therapy and doesn't know the administration techniques involved in the procedure.

The note should clearly make out that the physician demonstrated the inhaler to the patient separate from the administration for treatment. Or else, the insurer may think you're trying to report a service twice.

Here's a tip that'll stand you in good stead: Even though technically not called for it may help to link separate diagnosis codes to the E/M and the nebulizer treatment. For example, you could link 786.05 to 99213, and link the emphysema code to 94640.

Easy bruising with no identifiable cause? Report 782.7

If you are wondering what the ICD-9 code for easy bruising is, read on and find out for yourself.

What's easy bruising?

Easy bruising is a symptom of another condition rather than a standalone diagnosis. As such, the ICD-9 code depends on whether or not the family physician identified a cause. If you identify the cause, then code for the specific disease. But again if no cause is pinpointed, then report for the symptoms.

How to report easy bruising?

For easy bruising with no identifiable cause, report 782.7 (Spontaneous ecchymoses). An individual may be ailing from other diseases that predispose him to develop bruises even with minimal trauma (say for instance a light rap on the hands), which normally will not happen to normal people, thus resulting in "easy bruising." Diseases that could result in this include platelet or coagulation disorders (thrombocytopenias), bone marrow disorders, hemophilias, liver diseases, and Marfan's syndrome. Aging and medications (for instance aspirin, prednisone, and other nonsteroidal anti-inflammatory drugs) can also lead to easy bruising. For patients suffering from these conditions, bruises seem to appear spontaneously without any identifiable reason.

What is ecchymosis, purpura and petechiae?

An ecchymosis is a bruise larger than 1 cm. A bruise less than 1cm but not less than 3 mm is said to be a purpura. A bruise less than 3 mm is a petechiae. Code 782.7 applies also to petechia but not purpura, which has various other codes (287.0-287.9) depending on the etiology.

Bruises from trauma can take place owing to a variety of reasons, including falls, accidents and post-surgeries. Normally, report codes 920-924 for bruises secondary to trauma. Say for instance a soccer player who was seen by a family pactice coding for bruises in the heel, report 924.20. Remember that as per ICD-9, these codes exclude contusions that are incidental to specific categories of injuries, like crushing injury, dislocation, fracture, internal injury, intracranial injury, nerve injury, and open wound.