Coding Consult

September 17, 2004

Answers to your questions about...pre-op exams, smoking counseling, 99313 or 99302?

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Pre-op exams

Q: What's the correct sequencing for diagnoses associated with a preoperative exam?

A: When you submit claims for pre-op exams and diagnostic tests, list the appropriate V code (V72.81-V72.84, preoperative examinations), with the reason for the surgery as the secondary code, according to CMS' Transmittal 1719, accessible at www.cms.hhs.gov/manuals/pm_trans/R1719B3.pdf(PDF file).

For example, say an ophthalmologist requests a pre-op clearance for a hypertensive 70-year-old man scheduled for cataract surgery. You do an E&M service and order an ECG and a blood draw for various lab tests.

Report V72.83 (other specified preoperative examination) for the consultation (99241-99245, office consultation for a new or established patient), V72.81 (preoperative cardiovascular examination) for the ECG (93000, electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), and V72.83 for the blood draw (G0001, routine venipuncture for collection of specimen[s]).

Use the reason for the surgery—366.13 (anterior subcapsular polar senile cataract)—as the secondary diagnosis and assign a diagnosis for the patient's hypertension (401.1, essential hypertension; benign). Also, make sure you comply with the rules governing use of consultative codes.

Smoking counseling

Q:Will Medicare insurers pay for smoking-cessation treatments? If so, what codes and documentation should we use?

A: Medicare and many private payers will pay for smoking-cessation counseling as long as you're the one doing the counseling, not an NP, PA, or other staff member. That's because the government lists the code as a "demo project"—G9016 (smoking-cessation counseling, individual, in the absence of or in addition to any other E&M service, per session [6-10 minutes] [demo project code only]).

If you yourself counsel a patient regarding smoking, you should include this service with the E&M code.

99313 or 99302?

Q:I did a history, an evaluation, and medical decision-making on a nursing facility patient who now has pneumonia in addition to previously diagnosed influenza. The patient requires IV antibiotics and nasal oxygen. Should I report the service with 99313 or 99302?

A: Report 99302 (E&M of a new or established patient involving a nursing facility assessment, which requires these three key components: a detailed interval history, a comprehensive examination, medical decision-making of moderate to high complexity . . .) for nursing facility care if the problem resulted in a "major permanent change in status" that requires a new medical care plan.

Assign 99313 (subsequent nursing facility care, per day, for the E&M of a new or established patient, which requires at least two of these three key components: a detailed interval history, a detailed examination, medical decision-making of moderate to high complexity . . .) when the change in status is not permanent and a new medical care plan is not necessary.

Although the patient's pneumonia (487.0, influenza; with pneumonia) is serious, this condition probably wouldn't cause a permanent change in status. So the likelihood is that you'd report 99313, as long as documentation supported all three key components that the nursing facility assessment code requires.

 

This information 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 www.codinginstitute.com.

 



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Medical Economics

Sep. 17, 2004;81:17.