What’s trending? Common coding questions from medical practices

CodingIntel has answers. Although CodingIntel isn’t a Q&A service, some questions come up over and over when I meet with medical practices. Here are a few of the most commonly asked questions and links to additional articles on each topic.

 

Colonoscopy

How do I determine if a consult is screening or diagnostic?

A screening colonoscopy is done according to the recommendations of the US Preventive Services Task Force for a patient with no signs, symptoms or complaints. A diagnostic colonoscopy is done when a patient has a sign or symptom, such as bleeding or anemia.

Can we bill for colonoscopy consults?

You can bill for an E/M service prior to a diagnostic colonoscopy for all payers. For screening colonoscopies, Medicare considers the E/M prior to a screening a routine service and does not reimburse for the service. Other payers may allow an E/M prior to a screening colonoscopy.

Read more:

Coding for screening colonoscopy

Diagnosis coding for screening colonoscopy

 

Anticoagulation management

If a patient has a home PTINR test and the nurse adjusts the medication dose, can we bill a nurse visit the next time the patient is seen?

No, you can’t bill a nurse visit for the work done over the phone on a different date.

And

How do I code for remote monitoring of patients on warfarin?

This blog post answers questions about anticoagulation management.

 

Screening for Vitamin D Levels

What is a good replacement code for vitamin D deficiency? E55.9?

I assume that you are receiving denied claims when screening for vitamin D. The answer is, there is no replacement. Screening for vitamin D levels is not considered medically necessary by the U.S. Preventive Services Task Force. If a physician wants to screen a patient, and the patient agrees, have the patient sign an Advance Beneficiary Notice or waiver of liability notifying them that it will be a patient due service.

 

Pap Smear

Why don’t commercial payers pay for Q0091?

Why questions in coding are really hard! Some payers do recognize and pay for Q0091, obtaining a screening pap smear. Keep in mind that this HCPCS code was developed by Medicare to report obtaining and preparing a screening pap smear at covered intervals (yearly for high risk patients, every other year for low risk patients). It is not for use with a diagnostic test. Other payers may or may not recognize and pay for this service, defined by this HCPCS code.

Billing for a pap smear” is one of the most frequently read articles on CodingIntel. Take a moment to read it, if you haven’t done so.

 

Critical care

Here are the most common critical care questions:

• “Payers are denying critical care codes for services done by the trauma team, when the ED doctor has seen the patient, even though our specialty designation is different. (Same tax ID)”
• “We have a critical care specialist who recently joined our group, and she is performing a lot of critical care with long duration times.”
• “The coding team is downcoding from critical care codes to E/M codes.”
• “When can I bill for critical care in the post-op period?”

The answers to these questions can be found in the articles and resources below:

Non-members will see a preview of these member-only resources. Become a member to access them in their entirety.

• CPT^® and CMS rules for critical care | What’s the difference
• Coding Critical Care Services | Webinar
• Critical care for general surgery and trauma surgeons
• Critical care Q&A
• Critical Care Coding guide
• Critical Care Services | Everyday Coding

 

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