The Coding Primer

1
The Coding Primer

• How to Code basics for primary care providers.
• Updated for 2009

2
Coding Cant Live With It. Cant Live Without
It.

• Coding is important because it builds the
  electronic health record.
• It is the language we use to collect our fees.
• It has become and will become even more the means
  by which we will be alotted cash and manpower.

3
How are we doing now?

• 573 encounters audited by our coders in August
  2007.
• 84.05 Diagnosis correct.
• 74.57 Eval/management codes correct.
• 67.18 CPT codes correct. Document what you
  performed. Method / Location / Quantity / Size /
  Layers / Time frames.
• 51 of encounters had errors found!

4
In general

• Code only what you know. If the diagnosis is
  likely or rule-out code for the symptoms the
  patient is having. E.g. CHF rule out can be coded
  as lower leg swelling.
• Dont code for resolved conditions. Instead use
  the v67 series for follow up exams.
• List complicating factors. Comorbidities, other
  chronic conditions the patient may have, adverse
  effects of medications that may be indicated.
  Helps to determine the complexity of the decision
  making process you are making.

5
In general

• Try to be clear about taking intermediate steps
  to address a patients condition. This can boost
  the complexity of the condition to the coder.
  Trying first physical therapy, nsaids prior to
  surgical consideration for example.
• Use the 50 button as the exception, not the
  rule.

6
In general

• Be specific about reviews of labs or xrays. Labs
  reviewed with patient showed elevated wbc
  indicating sepsis or inflammation. If a patient
  is following up blood pressure check tell what
  was wrong with the blood pressure to begin with.
• Be sure to add the nurse, MA or corpstaff as an
  additional provider to help show clinic workload.

7
In general

• Medical necessity should drive ordering of labs
  or other diagnostic studies. Write a story that
  tells why these labs need to be done. The
  complexity of the office visit is based on the
  story not on the fact that so many labs were
  ordered.
• When applicable, code obesity as it can help to
  increase the medical decision making score.

8
In general

• Collect credit for diagnostic decisions. If the
  provider went through the medical decision making
  process to determine a patient needed a certain
  test, even though the patient refused the test,
  the provider should receive credit for that
  process, provided the process is documented. E.g.
  colonoscopy screening / tobacco cessation
  counseling / obesity nutrition consults.

9
In general

• For residentsGive name of staff you discussed
  the case with.
• Vital signs must be stated to have been reviewed.
• EKG must be reviewed in your note to obtain
  credit for having done it (CPT 93000).
• LOOK! At your clinic favorites for CPT codes and
  for Diagnoses!

10
Code for the -25 modifier.

• When a procedure is done separate from the office
  visit diagnosis. When providing a specific
  treatment plan during a prev med visit. E.g.
  during a PAP smear patient brings up depression
  and you counsel and provide medical therapy.
  During an EST patient elects to start tobacco
  cessation and you perform counseling.

11
How to Code for Preventive Med Visits

• V20.2 visit for Well baby, Well child
• V72.31 Normal Pelvic Exam with Cervical PAP (Well
  Woman)
• V76.2 Screening Pap
• V70.0 Normal Routine History and Physical (Well
  Adult)
• V70.3 School/Camp Physical
• Disposition Age-Appropriate Prev Med Code!
  E.g. 99395 RVU 1.36 (99213RVU 0.67)

12
How to Code for Routine OB Care

• V22.0 Supervision of Normal First Pregnancy
• V22.1 Supervision of Pregnancy
• V22.2 Pregnancy incidental to condition.
• CPT ! NOB 0500f, Antepartum 0502f,
  Post-Partum Exam 0503f
• Disposition 99499
• 99499 with 0500.0502,0503 0.83 rvu !
• 992130.67

13
How to Code for Well Woman Visit

• V72.31 Routine Physical Exam with a GYN
  component. When cervical PAP Smear is performed
  must add diagnosis V76.2 Screening PAP.
• If s/p hysterectomy V72.31 still applies with
  V76.47 for vaginal PAP.
• CPT/HCPCS! Q0091 Obtain PAP / Transport to
  Lab
• 87210 wet prep/koh (done and interpreted in
  clinic) 82272 Hemoccult from DRE (done in
  clinic).
• Q0091 RVU 0.37
• Disposition Use age-appropriate Prev Med Code!

14
How to Code Tobacco Cessation

• 305.1 Nicotine Dependence
• New! CPT in EM section add Additional EM
  code using -25 modifier.
• 99406 3-10 minutes of cessation counseling
• 99407 10 minutes of cessation counseling
• 96153 provider group visit
• HCPCS S9453 non-provider cessation counseling
• 99406 RVU 0.24
• 99407 RVU 0.50

15
How to Code Obesity

• 278.00 Obesity (bmi 30-39)
• 278.01 Morbid Obesity (bmi39)
• 278.02 Overweight (bmi 25-29)
• V77.8 visit for screening exam obesity

16
How to Code for Skin Biopsies

• Punch / Shave Biopsy of
• Macules and Papules 709.8
• Subcutaneous Nodule 782.2
• Acrochordon 701.9
• CPT Biopsy Skin11100
• Each additional biopsy 11101
• CPT Skin tag removal 11200 (up to 15 lesions)
• Each additional 10 biopsies 11201
• CPT Destruction of benign lesion by cryotherapy
  17110 up to 14 lesions 17111 15 or more
  lesions.

17
How To Code for Exercise Stress Testing

• Exercise Stress Test 786.50 Chest pain or
• v81codes visit for screening exam
  cardiovascular disorders (no hx recent chest
  pain)
• CPT Cardiovascular Stress Test 93015
• CPT Stress Test with Pharmacologic Challenge
  93015

18
How To Code for Colposcopy

• Colposcopy Diagnosis 795. series Abnl PAP of
  Cervix
• CPT Colposcopy without biopsy 57452
• CPT Colposcopy with biopsy of cervix and ECC
  57454
• CPT Colposcopy with ECC only 57456
• CPT Colposcopy with biopsy only 57455

19
How To Code for Vasectomy

• Pre Vasectomy Counseling and Examination v25.09
• Vasectomy Procedure v25.2 Surgery of Male
  Genitalia Sterilization
• CPT 55250
• Post-Vasectomy Follow-up v67.00

20
How To Code Chronic Kidney Disease

• 585.9 Chronic Kidney Disease (NKF Classification)
• 403.9 Hypertensive Chronic Kidney Disease

21
How To Code Adverse Drug Reaction

• E947.9 Adverse Effect of Drug Therapy
• Enter Medication as ADR / list effect drug had
  on patient.

22
How To Code for Diabetes

• Diabetes 250.00
• Pre-Diabetes (Impaired Glucose Tolerance) 790.29
• Gestational Diabetes 648.80
• Visit for Screening Exam Diabetes v77.1
• CPT for Foot Exam
• 2028F for normal exam G0247 if neuropathy is
  diagnosed

23
How To Code for Alcohol Use Counseling

• 305.00 Alcohol abuse, unspecified
• (non-dependent)
• 303.90 Alcoholism, unspecified
• (dependent)

24
How To Code for Mammogram Review / Screening

• Mammogram Screening v76.12
• CPT Review Mammogram Results 3014F

25
How To Code for Osteoporosis Screening

• Osteoporosis 733.00
• Visit for screening exam osteoporosis v82.81
• Anticipatory Guidance Osteoporosis v65.49

26
How To Code for Colon Cancer Screening

• Visit for Screening neoplasm malignant colon.
  V76.51
• Heme Occult testing CPT 82272 if interpretation
  is performed in the clinic
• Flex Sig CPT 45330

27
How to Code for Screening Exams

• V76.51 screening colon cancer
• V77.1 screening, diabetes
• V76.9 screening cancer, unspecified
• V77.91 screening lipid disorders
• V81.0 screening cardiac disease
• V82.9 screening, unspecified