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Coding Cues


Answers to your questions about...HPV vaccine; prolonged service codes; second opinions

HPV vaccine

I've started administering the new human papilloma virus (HPV) vaccine. Which code should I use for this service?

You should submit 90649 (human papilloma virus [HPV] vaccine . . . ) for the vaccine and 90471 (immunization administration . . . ) for the administration. Your diagnosis code should be V04.89 (need for prophylactic vaccination . . . ).

Prolonged service codes

I saw a Medicare patient in the office who had multiple problems and an extremely complicated history. The visit took 100 minutes. Based on the documentation, I can report 99215. Can I report the additional 60 minutes with add-on codes 99354 and 99355?

No. You can use 99354 only. This add-on code allows you to bill for the 60 uncaptured face-to-face minutes you're left with after coding 99215. CPT allots about 40 minutes for this level-five established patient visit.

Coding 99215 with add-on code 99354 (prolonged physician service in the office or other outpatient setting . . . ) allows you to capture prolonged service lasting 30 to 74 minutes. Your visit, which contains 60 minutes beyond 99215's usual 40-minute service, falls within this time frame.

You can't bill 99355 (which always is reported along with 99354) with a level-five established patient visit until documentation supports a minimum of 75 minutes of prolonged service. In your case, you'd need an additional 15 minutes with the patient before you could report one unit of 99355. In other words, the visit would have to include 115 minutes or more of face-to-face time.

Remember that:

Second opinions

I know that CPT deleted the confirmatory consult codes for billing second opinions. How should I report the work I do for this service?

If a patient comes to you on his own, requesting a second opinion, you should treat the office visit as you would any other E&M visit. So you'd report the appropriate E&M office visit code.

If a second opinion is requested by a physician, and you meet the requirements for a consultation service, you'd report the visit with the appropriate office consultation codes for new or established patients (99241-99245).

In a facility setting, you'd bill a second-opinion consultation that's arranged through an attending physician using the appropriate initial inpatient consultation code (99251-99255) assuming, again, that you meet the consultation requirements. When you don't meet the consultation requirements, use the subsequent hospital care codes (99231-99233) in the hospital setting and the subsequent NF care codes (99307-99310) in a nursing facility.

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.

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