Pathology and radiology codes; Home colorectal screening; Depo-Provera injections
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Q:A patient presented with midabdominal pain that had been going on for 12 hours with one episode of vomiting, but with no diarrhea, fever, or dysuria. I examined him and took an X-ray and did a urinalysis. Are those part of the E&M code, or can we bill separately?
A: The exam portion of the E&M visit does not include diagnostic testing. You can always bill pathology and radiology codes separately from the office visit.
The most appropriate office visit code in your case is likely 99213 or 99214, depending on the level of history, exam, and medical decision-making. Link 789.07 (abdominal pain, generalized) to the E&M code. Report 74000 (radiologic examination, abdomen; single anteroposterior view) for the X-ray, and the appropriate urinalysis code (e.g., 81000, urinalysis, by dipstick or tablet reagent . . . ) for the urinalysis.
Q: I routinely give patients colorectal screening kits to take home. With the type of test we use, the patient drops the guaiac paper into the toilet after a bowel movement, watches the test area and control boxes to see if any parts of the paper change color, then documents the results on a card and mails it to the office for review. Is 82270 an appropriate code for this? I'm unsure because I'm not performing the screening myself.
A: No, you can't use 82270 (blood, occult, by peroxidase activity [e.g., guaiac] qualitative; feces, 1-3 simultaneous determinations) or the HCPCS equivalent G0107 (colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations) for this type of test. These codes are for another type of guaiac card on which the patient places a small stool sample, then returns that card to the office, where a developing agent is added and interpreted.
The only possible code you can use is 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered) to cover the cost of the cards. But use this code only if you pay for the cards. If a drug company or lab supplies the cards at no charge, don't bill for them.
Q:When patients come in for Depo-Provera injections, I charge for the injection administration, the Depo-Provera itself, and the nurse visit. None of our other providers bill all three. Who's correct?
A: Medicare says you can't bill simultaneously for administration of an injectable medication (90782, therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular]) plus a nurse visit (99211, office visit for the E&M of an established patient that may or may not require the presence of a physician). You can either bill the 99211 and the medication (in your case, J1050 or J1055) or bill the injection administration and the medication. Most private payers follow this rule as well.
Which option should you choose? If the nurse evaluates the patient at all, use 99211. If the nurse just gives an injection, use the injection code.
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