Telephone orders; stitch removal; stool testing; after-hours care
Q: Our office has been treating an anemic patient with Procrit. She moved to a nursing home and is now unable to come to the office for treatment, so I've called in orders for Procrit to the nursing home. Can I charge for these phone orders?
A: Medicare won't reimburse for telephone conversations, as specified in Section 15512 (B) of the Medicare Carriers Manual: "Do not pay for telephone calls (codes 99371-99373) because payment for calls is included in payment for billable services." You can bill only for face-to-face services on an outpatient, noncritical care basis.
Some private insurance companies do provide reimbursement for telephone conversations, though. Check with the payer to determine its policies and procedures regarding codes 99371-99373.
Q: Does Medicare cover fecal-occult blood testing for patients who are not at high risk for colon cancer, for instance, having no personal history of cancer? If so, what CPT and ICD-9-CM codes should I use to get paid?
A: Medicare beneficiaries who have no symptoms, whether or not they are at high risk, are encouraged by Medicare to have annual screening FOBTs. If they obtain cards from their physician, take them home, obtain samples as directed on the cards, and return the cards to the office for evaluation, Medicare will pay for this service for any beneficiary once a year.
The service should be billed with HCPCS code G0107 (colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations). Use ICD-9-CM code V76.51 (special screening for malignant neoplasms; colon).
Confusion over Medicare coverage is not the only common FOBT coding question. Many focus on the inconsistent local medical review policies for 82270 (blood, occult, by peroxidase activity [e.g., guaiac], qualitative; feces, 1-3 simultaneous determinations).
Code 82270 is for diagnostic testing of patients who have symptoms consistent with suspected GI bleeding. Local medical review policies, however, are not consistent on which diagnoses are covered. Because of this inconsistency, 82270 was addressed as a part of the National Coverage Determinations for laboratory tests. The coverage decisions standardize covered and noncovered diagnoses across the country and were implemented in January 2003 to allow carriers to bring their local medical review policies into line. (To view the National Coverage Determinations policy, go to www.cms.gov/ncd/labindexlist.asp.)
Q: I am the physician in our group practice who stitches. But when the patient returns, a different physician removes them. Can that second physician bill for suture removal?
A: No, he can't charge separately for suture removal because he's a member of the same group. CPT generally includes the work involved in stitch removal in the reimbursement for suturing.
If another provider (for example, an emergency department physician) puts in the sutures and then the patient comes to your office for stitch removal, you could use the low-level E&M code 99211 if suture removal was the only E&M service provided during the visit.
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Coding Consult: Answers to your questions about. . ..
Jun. 20, 2003;80:18.