Coding Consult

November 18, 2005

Answers to your questions about...unconfirmed pregnancy; patient monitoring; repeating procedures

Unconfirmed pregnancy

Q. Under what specific circumstance should I use the diagnosis code V72.40?

A. You can only use V72.40 (pregnancy examination or test, pregnancy unconfirmed) when, at the end of the visit, you can't confirm whether a patient is pregnant.

Patient monitoring

Q. I have patients wait in the office 15-20 minutes after an allergy injection so I can detect any adverse reactions to the shot. Can I bill 99213?

A. No. You can't bill for the time you spend monitoring a patient. However, if you provide a service separately identifiable from the injection-such as an asthma evaluation-then you can report an appropriate E&M code.

For instance, say an established 32-year-old female patient comes to you for an allergy injection. After you administer one injection, you have her wait for 20 minutes to make sure she doesn't have a reaction. After 20 minutes, the patient reports shortness of breath (786.05). You evaluate her to determine whether it's an adverse reaction to the injection or an asthma flare. In this instance, you should report 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection).

Because you also administered a baseline spirometry to check for decreased lung function, you should report 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and, if the documentation supports it, 99214 for the E&M services you performed.

Repeating procedures

Q. When is the most appropriate time to use modifier –77?

A. Use modifier –77 (repeat procedure by another physician) when you perform the same procedure as another doctor on the same day but during a different encounter.

For example, say that prior to your office hours, one of your patients goes to the ED complaining of chest pain (786.5x). The patient has an electrocardiogram and chest X-ray done there. The ED physician determines that the patient's pain isn't cardiac in nature, and sends him home. But later that day, the pain returns, and the patient comes to your office. You repeat the ECG and the X-ray. That means you would need to append modifier –77 to both 93000 (electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) and 71020 (radiologic examination, chest, two views, frontal and lateral).

Appending modifier –77 will not affect your reimbursement from Medicare, as long as your documentation shows why you had to repeat the procedure. Medicare needs the modifier for informational purposes only. But private carriers may have different policies regarding modifier –77 that influence your reimbursement, so check with them before using it.

This information 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.