Centers for Medicare and Medicaid Services won't pay codes for online services; how to respond to an insurer's audit; coding for multiple injections on the same day; billing for angiography and its interpretation

May 10, 2011

Understand the rules regarding online services.

Key Points

Q: Do codes exist for the reporting of online services?

HOW TO RESPOND TO AN INSURER'S AUDIT

A: Code 36410 is to be used for the performance of venipuncture on a patient aged at least 3 years and requiring a physician's skill for the draw, whereas code 36415 is to be used for the performance of routine venipuncture, typically by a lab tech.

The difference in reimbursement is pretty substantial. Reimbursement for code 36410 is in the range of $18 to $20, depending on the geographic area of the country in which you practice. Medicare normally bundles the draw fee into the lab if the lab work is performed in the office, or into the evaluation/management (E/M) service received by the patient the day the venipuncture is performed.

Analyze the difference in fees. If it is substantial, then contact a qualified health law attorney to assist you in reviewing the insurer contract regarding the statute of limitations on audits or to determine what other options are available to you.

CODING FOR MULTIPLE INJECTIONS ON SAME DAY

Q: What are the rules for coding for multiple injections (such as diphenhydramine [Benadryl], methylprednisolone [Depo-Medrol], or ceftriaxone [Rocephin]) given to the patient on the same date of service, at the same patient encounter, in the physician's office?

A: Use code 96372 to report the administration of a therapeutic, prophylactic, or diagnostic injection. The drug or substance should be reported, too, using the appropriate "J" code.

Some insurers will recognize only one administration code, even though separate supplies are used, and some insurers will not allow payment for administration of the injectable when an E/M service is provided on the same date.

BILLING FOR ANGIOGRAPHY AND ITS INTERPRETATION

Q: I read angiograms on my patients in the hospital. Formerly, we billed 93555–26 and received payment. This code has been deleted. What code should I use to report those services now?

A: Cardiology codes in general underwent significant changes in the 2011 revisions of the Current Procedural Terminology. Angio-graphy and its interpretation have been bundled into most of the cardiac catheterization codes and no longer are separately payable.

The parenthetical instructions in the manual that indicate the deletion of 93555 refer the reader to the section notes at the beginning of the cardiac catheterization codes for clarity. The changes are described in detail, including what is and what is not bundled into each service.

The author is president of Healthcare Consulting Associates of NW Ohio Inc., Waterville, and a Medical Economics editorial consultant. She has more than 30 years of experience as a practice management consultant and also is a certified coding specialist, certified compliance officer, and certified medical assistant. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it to medec@advanstar.com.