Ambulatory Coding & Payment Report
Reader Question: Training for an Indwelling Catheter
Question: Which diagnosis code should I use when a patient visit involves only training on how to care for an indwelling catheter? In his documentation, the doctor does not mention the cancer that will be treated nor does he provide a history and physical. Also, how should we treat visits for catheter care and dressing changes when the medication is dispensed as a take-home drug to either the family or a home-health nurse?
South Dakota Subscriber
Answer: With reference to the ICD-9 code, the fact that no specific disease is noted is a problem. This chart should be returned to the physician for more accurate diagnosis because the underlying illness could be listed as a secondary diagnosis. With reference to the CPT code, 99211 (evaluation and management of an established patient, that may not require the presence of a physician) is a low-level code for outpatient visits that involve E/M. Because this code has no specific requirement of history, exam or medical decision-making, it would be appropriate in your situation because the physician does not mention a history and physical. If the patient is present for the catheter care, then 99211 is appropriate.
But if the patient is not present, you are just dispensing medications and supplies. Depending on the medication, there may be appropriate coverage under the APCs, but the medication must be specified. If the medication is dispensed to a home-health nurse who is an employee of the hospital, code G0154 (services of skilled nurse in home-health setting) may be appropriate. This applies to the actual home visit -- not the office setting -- for dispensing the medications and supplies.
South Dakota Subscriber
Answer: With reference to the ICD-9 code, the fact that no specific disease is noted is a problem. This chart should be returned to the physician for more accurate diagnosis because the underlying illness could be listed as a secondary diagnosis. With reference to the CPT code, 99211 (evaluation and management of an established patient, that may not require the presence of a physician) is a low-level code for outpatient visits that involve E/M. Because this code has no specific requirement of history, exam or medical decision-making, it would be appropriate in your situation because the physician does not mention a history and physical. If the patient is present for the catheter care, then 99211 is appropriate.
But if the patient is not present, you are just dispensing medications and supplies. Depending on the medication, there may be appropriate coverage under the APCs, but the medication must be specified. If the medication is dispensed to a home-health nurse who is an employee of the hospital, code G0154 (services of skilled nurse in home-health setting) may be appropriate. This applies to the actual home visit -- not the office setting -- for dispensing the medications and supplies.
- Published on 2001-08-01
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