Coding Cues

November 17, 2006

Answers to your questions about...NF admissions; mole removal; stress tests

NF admissions

After I discharged a patient from the hospital, I admitted him to a nursing facility. Can I submit the NF admission if I didn't actually go to the NF for it?

No. You should code the hospital discharge only (99238, hospital discharge day management; 30 minutes or less; or 99239 . . . more than 30 minutes). The nursing facility admission (99304-99306, initial nursing facility care, per day, for the evaluation and management of a patient . . .) requires a face-to-face physician-patient encounter at the facility.

Mole removal

What's the appropriate code for removal of a mole?

For example, if you removed a 0.7-cm lesion from the left cheek, you'd report 11441 (excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm).

If you removed a 1.5-cm lesion from the neck, you'd report 11422 (excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm).

All excision in these examples include simple closure. If you had to perform an intermediate or complex closure, you may report the closure separately, but only if the wound is larger than 0.5 cm. For instance, in the second scenario above (a 1.5-cm lesion of the neck), you use a layered closure to close the wound after excision. In this case, you would report both 12041 (layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less) for the closure and 11422 for the excision.

Many payers consider mole removal to be a cosmetic (and therefore noncovered) procedure unless you can document the suspicious (that is, potentially cancerous) nature of the mole.

Stress tests

I ordered a cardiac stress test for a hospital patient who complained of chest pain (786.50) and palpitations (785.1). I supervised the stress test and provided a written interpretation and report. What cardiovascular stress test code should I use?

You should report two procedure codes. Report 93016 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report) for your supervision and 93018 (. . . interpretation and report only) for your written interpretation and report.

Don't use the comprehensive cardiac stress test code 93015 (. . . with physician supervision, with interpretation and report). You'd use that only if you'd administered the stress test in your office and also provided the procedure's supervision, interpretation, report, and technical component (that is, you own the equipment).

This information is adapted from material 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 http://www.codinginstitute.com.