Charging for time spent on paperwork, Coding when you can't get a history from the patient, Billing for travel time
Answers to your questions about . . .
Q: Can I charge the insurance company for my time in filling out disability paperwork? Most of the forms are 10 pages long.
A: You can charge for filling out disability paperwork by billing 99080 (special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) with the appropriate E&M office visit code. Code 99080 can only be reported in addition to another service.
You can also code for disability paperwork with 99455-99456 (work related or medical disability examination). These codes include "completion of necessary documentation/certificates and report."
Q:I consulted in the hospital on a patient who was obtunded and, therefore, unable to give a history. How should I bill for this?
A: Although there are exceptions to the history requirement for urgent/emergent circumstances, it's not clear that your scenario would be one. To qualify for an exception, you must be unable to obtain a history not only from the patient but from "any other source." In addition, the medical record must document that the patient is at high risk and that immediate attention is critical.
When you document the patient's urgent medical condition and inability to communicate, the risk of delaying immediate treatment, and the lack of another source for history, you can code the level of history as comprehensive. You'll normally encounter these circumstances in ED patients who present with life-threatening conditions such as cardiac or respiratory arrest.
Your scenario, on the other hand, appears to be analogous to that faced by pediatricians unable to obtain a history directly from infants or young children. It's likely that you could have obtained a history from the nursing staff, the requesting physician, the written consult request, or the patient's record.
Q: One of my Medicare patients with multiple medical problems fractured a hip and underwent surgery at a hospital 150 miles away. She felt that the local internists weren't able to manage her complicated medication regimen and asked me to visit and consult on her care. Can I get paid for my travel time and expense?
A: Your Medicare carrier may be willing to reimburse you. Medicare recognizes extraordinary circumstances when travel should be paid. To qualify, the distance must be unusually long (more than 100 miles each way), and there can be no other physicians qualified to perform the service within that distance of the hospital.
Medicare requires a report describing the circumstances and distances involved, and will review these types of claims on a case-by-case basis. Only one trip will be paid regardless of the number of patients seen or services provided.
Because you traveled more than 100 miles each way, your carrier would need to determine that your patient was correct in her judgment that none of the local physicians was qualified to manage her care. Bill your travel time and expense with 99082 (unusual travel [e.g. transportation and escort of patient]) and be sure to include a report and a cover letter. Cite Medicare Carriers Manual section 15026 and national coverage policy PHYS-054 in your cover letter.
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Coding Consult: Answers to your questions about . . .. Medical Economics 2002;12:17.