Coding Consult

December 16, 2005

Answers to your questions about venom injections; disability retirement paperwork

Venom injections

Q. How should I code an insect venom injection to treat anaphylaxis from a bee sting?

For the injection, use 95130 (professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract; single stinging insect venom).

Bridge-wire removal

Q. A patient's bridge wire became imbedded in the underside of his tongue, and I removed it. Should I use 10120?

A. Yes. Code 10120 (incision and removal of foreign body, subcutaneous tissues; simple) is appropriate for this situation. If you had to treat an infection in the patient's tongue resulting from the imbedded bridge wire, you could have reported 10121 (. . . complicated) because the infection would make it a complicated procedure.

Remember that code 10120 covers both the bridge-wire removal and any repair you might have performed. If you report 12011 (simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) along with 10120, your carrier will likely deny the repair code.

If you performed an E&M exam in addition to the foreign-body removal, you can report the appropriate E&M code separately. Append modifier –25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to your E&M code to indicate that the bridge-wire removal was separate from the E&M service.

Disability retirement paperwork

Q. I have a patient who's applying for early retirement because of a disability. I've spent four hours filling out forms and reviewing 20 years of medical records to provide supporting medical information about her disability, in addition to seeing the patient on a weekly basis. Can I bill for this extra time?

A. Yes. The proper code depends on where the disability determination request came from.

Option 1: If a third party sent you a letter requesting the disability determination, report 99450 (basic life and/or disability examination that includes: measurement of height, weight and blood pressure; completion of a medical history following a life insurance pro forma; collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and completion of necessary documentation/certificates).

Option 2: If your patient presented a determination request to you, report 99080 (special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form).

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.