Coding cues: Answers to your questions about...

June 15, 2007

Answers to your questions about...tick removal; reciprocal services; hospital visit and discharge; cholesterol check

Key Points

Tick removal

I removed a tick from a patient's shoulder. What procedure code should I use to report this?

Usually visits for tick removal aren't complicated and don't require an incision. If that's the case, the removal is considered to be part of managing a problem, and you should report the visit using the appropriate E&M code based on the level of history, examination, and medical decision-making.

Reciprocal services

Another physician in the area will cover my patients while I take a vacation from my solo practice this summer. Can I submit claims to Medicare under this arrangement?

Yes. You can bill and collect for covered services that a substitute physician provides to your Medicare patients if you follow the rules for reciprocal billing.

Your substitute physician can only provide services and you can only bill under the reciprocal billing arrangement for a maximum of 60 days. This time period is continuous, and you count from the first day the substitute doctor sees your patients until you return to work. You'll need to count even the days in that period that the substitute doctor doesn't provide any services. If you're away longer than 60 days, the substitute physician should bill any services he provides in those days in his own name, not yours. If you come back to work and then take a subsequent vacation, a new period of coverage would begin with the new time taken off.

Submit the claim using your provider ID, and append modifier –Q5 (service furnished by a substitute physician under a reciprocal billing arrangement) to the procedure code. You'll have to include the substitute physician's provider ID on the claim form as well, and you should keep a record in your files of his provider number along with each service he provides.

Hospital visit and discharge

I saw a patient in the hospital and intended to submit 99231 (subsequent hospital care, per day . . . ) for my service. But the patient improved later in the day and I went back to the hospital that evening to arrange her discharge. Can I bill 99231 along with a discharge code?

No. If you see a patient more than once on the day of discharge, you can only bill for the discharge services (99238-99239). Payers won't pay for a subsequent hospital visit and a discharge visit on the same day by the same physician, or by physicians in a group of the same specialty.

Cholesterol check

As a new service, I'm going to perform cholesterol checks on some of our patients. How should I code this?

Use 36415 for the blood draw (collection of venous blood by venipuncture). If you have a lab in your practice and will analyze the results, you should report the appropriate cholesterol test code, such as 83718 (lipoprotein, direct measurement; high density cholesterol [HDL cholesterol]), 83719 ( . . . VLDL cholesterol), or 83721 ( . . . LDL cholesterol).