Code Hospital Discharge for Actual Date of Face-to-Face Visit by slappypappy121


									                           Coder’s Corner Compilation 2009

Code Hospital Discharge for Actual Date of Face-to-Face Visit
Ever wonder what to do when your physician or non-physician provider (NPP) sees an
inpatient late in the day and performs the discharge management service (99238-99239)
but the patient does not go home until the following day?

According to CMS Transmittal 1460, the hospital discharge day management service
should be reported for the date of the actual visit by the physician or NPP, even if the
patient is discharged on a different date.

Remember, only the attending physician of record or a physician acting on behalf of the
attending physician may report hospital discharge codes 99238-99239.

ICD-10-CM Pushed Back to 2013
The Department of Health and Human Services (HHS) released a final rule on January
15, 2009, that replaces the ICD-9-CM code set with the ICD-10 code sets October 1,
2013. The proposed date for implementation had been October 1, 2011.

According to the Department of Health and Human Services, ICD-10 will fully support
quality reporting, pay-for-performance, bio-surveillance, and other critical activities.

A study conducted by Nachimsom Advisors* estimates the cost impact of the ICD-10
mandate on small physician practices to be $83,209. Costs for a medium practice could
be $285,195 and costs for a large practice could be as high as $2.7 million. ICD-10
requires five times as many codes as ICD-9-CM and will have a significant impact on
business operations for healthcare systems.

Many physician organizations, Medical Group Management Association and the
American Academy of Professional Coders were instrumental in convincing the
Department of Health and Human Services that additional time was needed to plan for
the implementation of ICD-10.

* Excerpts from article published by American Academy of Professional Coders. ICD-10—CM Fact Sheet Developed by Coalition,
“October 9, 2008.

The Centers for Medicare and Medicaid Services Requires new ABN
March 1, 2009
Beginning March 1, 2009, the Centers for Medicare and Medicaid Services (CMS) began
requiring “notifiers”, which includes physicians and suppliers paid under Part B and
some providers paid under Part A, to use form CMS-R-131 the revised Advanced
Beneficiary Notice of Noncoverage (ABN). This form replaces the former general use
form and the form for physician ordered laboratory tests.
The new form, available in English and Spanish and the notice instructions are now
posted on the Beneficiary Notice Initiative web page (\bni).

Key features of the new form include:

          A new title to clarify the purpose of the form;
          The ability to use the form for a service that is excluded from Medicare
          A mandatory field informing the beneficiary of the estimated cost of the
           service or supply being provided;
          An option for the beneficiary to choose to receive a service/supply, and pay
           for it out-of-pocket, rather than having a claim submitted to Medicare.

Diagnostic Testing for Swine Flu

The initial fear accompanying the emergence of the H1N1 (Swine Flu) virus appears to
be subsiding, but it remains an issue of high concern for public health officials. This
particular influenza A virus has not been seen in humans before so it is unlikely anyone
has a natural immunity. In a May 4th open letter to health care providers, Dr. Jason
Eberhart-Phillips, health officer for the State of Kansas, asks that specimens be obtained
in suspect cases and forwarded to the public health laboratory in Topeka. The letter also
notes that a rapid test may be helpful even though a negative result does not rule out the
presence of the virus.

For those practices intent on implementing a rapid test to help diagnose H1N1 infections,
the Centers for Medicare and Medicaid (CMS) lists several commercially available,
CLIA-waived, tests that identify influenza A type viruses. These tests detect influenza
antigens in respiratory specimens. The CPT code used to bill most of these antigen
detection tests would be:

87804 Infectious agent antigen detection by immunoassay with direct optical observation;

The Blue Cross Blue Shield of Kansas laboratory fee schedule indicates a MAP amount
of $41.32 for 87804. Medicare’s 2009 clinical laboratory fee schedule shows
reimbursement at $17.52. For clinics with a CLIA certificate of waiver, the QW modifier
would be added to 87804 when billing Medicare.

Healthcare consultant Margie Vaught, CPC, ( recommends using
ICD-9 code 487.8 in confirmed cases of H1N1 influenza. Absent a confirmed case it is
likely that one would code the presenting symptoms.

These rapid tests do not differentiate between the H1N1 virus and seasonal influenza A
viruses. The CDC advises clinicians to interpret the results of rapid diagnostic tests with
caution. Positive identification of an H1N1 flu infection can only be obtained by reverse-
transcription polymerase chain reaction (RT-PCR) or viral culture. Such tests are beyond
the scope of CLIA waived office laboratories. Additional information for clinicians on
H1N1, including specimen collection, preparation and submission for confirmatory
testing, can be found at the KDHE website listed below.

KDHE H1N1 information:

CDC H1N1 information:

CMS CLIA waived tests:

Dated material referenced in this article. Information current effective May 20, 2009.


Colonoscopy Billing Question Answered
Our physicians perform screening colonoscopy for patients with whom they have no
relationship. The patients’ primary care physician contacts our office to schedule
the procedure. Can we bill a patient visit prior to performing the screening

Many insurance companies, including Medicare, do not cover an Evaluation and
Management (E/M) service prior to a screening colonoscopy. Section 1862(a)(1)(A) of
the Social Security Act states that no payment may be made for items or services that are
not reasonable and necessary for the diagnosis or treatment of an illness or injury or to
improve the functioning of a malformed body member. In addition, section 1862(a)(7)
prohibits payment for routine physical checkups. These sections prohibit payment for
routine screening services, those services furnished in the absence of signs, symptoms,
complaints, or personal history of disease or injury. You may access this information by
going to the Social Security Online website at:

Because Medicare generally considers an E/M service prior to screening colonoscopy to
be medically unnecessary, it is recommended that you notify the patient in advance and
have the patient sign an Advanced Beneficiary Notice of Non-Coverage (ABN). You can
then bill the patient for the visit that takes place prior to the screening colonoscopy.

Billing a pre-procedure E/M code may be appropriate if a patient is being scheduled for a
diagnostic colonoscopy due to symptoms (e.g., occult or active bleeding, history of
polyps, ulcerative colitis.) In this case, the diagnosis code should reflect the signs or
symptoms with which the patient presents.


To top