Coding Consult

September 15, 2006

Answers to your questions about...back-to-back hospital admissions; Sports physicals; Minor puncture wounds

Back-to-back hospital admissions

Q. How should I code a hospital stay when the patient is admitted one day for observation, then discharged, and then is admitted the next day as an acute patient?

Q. Should I use 97005 and 97006 to report sports physicals?

A. No. The physical medicine and rehabilitation codes 97005 (athletic training evaluation) and 97006 (athletic training re-evaluation) aren't appropriate for the typical sports physical. From a CPT perspective, these codes are generally intended to be problem-oriented, and they include recognition and evaluation of an athletics injury as well as educational training related to the specific injury.

In comparison, a sports physical is typically a nonproblem-oriented encounter in which a physician evaluates and certifies a patient's involvement in organized sports.

When you examine a patient for a sports physical and you perform a comprehensive history and exam, report the age-appropriate code from the preventive medicine series (99381-99397). If you perform less than a comprehensive history and examination, report the appropriate-level office visit code, based on the history, exam, and medical decision-making, such as 99213 (office or other outpatient visit for the evaluation and management of an established patient . . .).

Typically, you'd use diagnosis code V70.3 (general medical examination; other medical examination for administrative purposes), which includes general medical exams for sports competition. Some payers, however, won't reimburse this diagnosis code. Consult the insurer about its rules.

Minor puncture wounds

Q. A patient presented with a puncture wound in the palm of her hand. I incised the wound to examine it and clean it copiously. There wasn't any sign of infection. How do I code this?

A. Use 20103 (exploration of penetrating wound [separate procedure]; extremity) for puncture wound care of an extremity, such as the hand. But depending on your documentation, it may be appropriate to append modifier –52 (reduced services).

According to CPT, 20103 covers the following services for a wound resulting from penetrating trauma: exploration or enlargement of the wound, dissection of the wound to determine penetration, removal of foreign bodies, debridement, and repair of minor blood vessels.

In your case, you clearly completed some of the services described in the descriptor for 20103. But you make no mention of removal of foreign bodies or repair of minor blood vessels.

If your care of the patient didn't include these other services, attach modifier –52 to signal to your carrier that you performed a reduced version of the service.

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com.