How to code a get-acquainted visit, Billing for an office visit and a hospital admission, The right code for fracture care
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Q: A new patient who'd chosen me for her PCP came in just to establish a relationship. I didn't examine her, but I spent 20 minutes telling her my outlook on health maintenance and promotion, and discussing preventive medicine. Am I correct to code the encounter 99202 for a new patient visit?
A: No. That new patient E&M code requires the physician to perform an examination and engage in medical decision-making.
The sort of visit you describe, often referred to as the "get-acquainted visit," should be coded 99401 (preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) and V65.49 (other counseling, not elsewhere classified; other specified counseling).
Q: A patient presents to the office, and I determine she needs to be admitted to the hospital that day. What is the proper way to bill for this? Should I use an E&M code for the office visit, a hospital admission code, or both?
A: You can bill under only one code in this situation, but you can use the E&M level of the office visit to raise the level of the hospital admission code, 99221-99223 (initial hospital care, new or established patient).
When an office visit occurs on the same day as a hospital admission, the services provided by the physician in the office are considered part of the initial hospital care. For example, if the doctor sees the patient in the office for a level 3 visit (say, 99213) and admits the patient to the hospital at a level 1 (99221), the office visit should allow you to bill a level 2 (99222) hospital admission code.
You'll have to use different coding, though, if you don't see the patient in the hospital on the day of the admission. For instance, you see the patient in the office on Monday and admit him to the hospital the same day. But you don't see the patient in the hospital until Tuesday morning. In this case, report the appropriate E&M office visit on Monday, and report the appropriate initial hospital care code on Tuesday. Don't add the E&M outpatient visit code to the hospital admission code because you have already billed separately for the office visit.
Q:A patient complained of pain in her finger after a fall. We X-rayed her finger and discovered that she had a fracture. I reduced the fracture in the office and placed the finger in a splint. I'm thinking of billing 26725 for the reduction, along with 29130 for the splint. Is this correct?
A: Assuming that you don't refer the patient to an orthopedist for follow-up care, you could bill 26725 (closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each) for the patient's fracture care. But you wouldn't be able to bill for the initial placement of the splint because it's included in the code. If you need to replace the patient's splint at a subsequent visit, you could bill 29130 (application of finger splint; static) for the replacement splint.
To understand the coding rationale for this case, you must first know what CPT includes in fracture care code 26725. Closed treatment of a fracture is nonoperative treatment. This type of treatment can be rendered in a physician's office and is normally reserved for simple fractures. Manipulation of a fracture is also known as a reduction or setting of the fracture "by the application of manually applied forces." CPT refers to splinting or strapping as "skin tractionthe application of a force to a limb using felt or strapping applied directly to the skin only."
Fracture care codes are subject to the global surgical package, which includes the manipulation of the fracture, the preoperative visit, and 90 days of uncomplicated follow-up care. If there is sufficient documentation, the preoperative visit may be billed separately with modifier 57 (decision for surgery).
To bill for an E&M visit, you must document all elements, including medical decision-making. If the only documentation in the medical record is a notation of a fracture along with documentation of the reduction and splinting, then a visit should not be billed.
If you see the patient for unrelated reasons during the 90-day fracture care global period, append modifier 24 (unrelated evaluation and management service by the same physician during a postoperative period) to the E&M codes to prevent them from being denied as part of the global surgical package.
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 Rd. South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit www.codinginstitute.com.
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