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Or could you be leaving money on the table?
Are you a pro at coding your medical procedures or could you be leaving money on the table?
Medical Economics collaborated with Mike Enos, CPC, CPMA, of Warwick, Rhode Island-based Enos Medical Coding to look at seven common coding issues facing today’s physicians. So whether you consider yourself a coding expert or a coding novice, we suspect you’ll learn something that will save you money.
Take our quiz and find out!
ANSWER: B; Commercial payers will want a “GT” modifier in addition to your 99201-99215 visit code to indicate that the visit took place via real time audiovisual conferencing between a patient and provider.
ANSWER: C (by the same physician on the same day as a procedure or other service); Note that different providers of the same group and same specialty are considered to be the same provider (for billing purposes) by most insurances.
ANSWER: B; It is not the familiarity with the patient that should drive the code, but the complexity of the decision making. 99213 should be used with a healthy patient with one stable condition or an uncomplicated illness; 99214 for dealing with more complicated issues.
ANSWER: B; The coding may be correct, however in order to bill this service under the physician’s name and NPI, “incident to” guidelines must be met. To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment. The physician does not need to be physically present in the room, but must provide direct supervision (present in the office suite and available to render assistance, if necessary.) Just remember: no new patients, no new problems.
ANSWER: B; Advance care planning services may be billed by physicians and non-physician practitioners whose scope of practice and Medicare benefit category include the services described by the CPT codes.
ANSWER: C; 90460 is for vaccine immunization through 18 years of age with counseling by a physician or other qualified healthcare professional. 90461 is an add-on code for each additional vaccine component administered. Note that the Tdap vaccine is made up of three components, so here, you would need to code two units of 90461. Code 90471 is used for patients who are older than age 18.
ANSWER: B; the patient seen by the internist in an inpatient setting is an established patient in the office as he has received professional services from the physician/qualified healthcare professional of the same specialty who belongs to the same group practice, within a three-year period, as defined in the CPT manual.
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