Gastroenterology Coding Alert
Get the Most Out of Hepatitis Coding With NPPs
Injection instruction usually a low-level E/M service While your gastroenterologist must reach a hepatitis C diagnosis, most non-physician practitioners (NPPs) are qualified to take on the post-diagnosis visits. And if an NPP can handle your hepatitis patients' follow-up visits, this will free your gastroenterologist up to see other patients - which will help the office's bottom line. Consult Usually Nets Hepatitis Diagnosis The first step in hepatitis C treatment is diagnosis. The gastroenterologist typically discovers hepatitis C in a patient during a consultation. NPP Can be Vital to Hepatitis Follow-Up Care Once the physician diagnoses hepatitis, an NPP is qualified to perform a lot of the duties involved in follow-up care, such as adjusting medications; ordering lab tests; and counseling and educating patients. Time Can Up E/M Level During these E/M visits, time can take over - especially if the patient has a lot of anxiety or questions. NPP Also Teaches Patients Injection Procedure NPPs in gastro offices also fill another important role: teaching hepatitis C patients how to inject Interferon at home. "Our NPPs don't inject patients with Interferon; they teach hepatitis patients to self-inject. This is often the primary reason for an [E/M] visit, in which the NPP teaches the patient about proper techniques, side effects, etc.," Garner explains. When the NPP teaches the patient about self-injection of Interferon, you should report the appropriate E/M level. Remember: Medicare wants you to use a G code for therapeutic injections in 2005. When the NPP injects Interferon into a Medicare patient in the office, you should report G0351 (Therapeutic or diagnostic injection) for the injection instead of 90782.
Benefit: Follow-up care for most hepatitis C patients is very detailed and involves regular office visits for six to 12 months and "lots of counseling and education," says Amy Walker, CPC, CCP, insurance supervisor at Gastrointestinal Associates in Knoxville, Tenn.
Join us for a quick look at the basics of hepatitis C coding, from diagnosis to follow-up visits. We'll also examine a couple of scenarios involving hepatitis care, and get some expert input on the subject from two experienced hepatitis coders.
"This consult is usually a higher level of service, since the gastroenterologist must evaluate risk factors, do extensive lab work, and counseling," says Walker.
Hepatitis candidates: The symptoms of hepatitis C patients may vary, but most "complain of fatigue, loss of weight, or jaundice," says Mary Garner, CPC, CCP, a coder with a lot of experience coding hepatitis C patients at Gastrointestinal Associates in Knoxville, Tenn.
People who have contracted hepatitis may also have used IV drugs in the past (or had relationships with IV drug users), or had a previous blood transfusion.
Listed below are some of the acceptable ICD-9 codes for hepatitis patients:
You should attach an ICD-9 code that best reflects the patient's hepatitis C on all her claims, starting with the initial consultation.
Example: Let's say a patient reports for a consultation and tells the gastro she has severe fatigue, and has lost several pounds in the past two days. After performing a comprehensive history and exam with moderate medical decision making, the gastroenterologist diagnoses acute hepatitis C without hepatic coma.On the claim, you should:
"The NPP usually takes over visits once [a hepatitis] diagnosis is made by the doctor. The doctor signs off on it all, but the NPP evaluates lab work, manages the drug administration and gives counseling," Garner explains. These visits can result in anywhere from a level 2 to a level 5 service, depending on the amount of counseling the patient needs.
Example: A patient who was diagnosed with hepatitis C two weeks ago reports for a follow-up visit. The NPP takes a blood test and asks the patient how she is feeling. The entire visit takes 17 minutes.
On your claim, you should:
"In some situations, like when teaching and counseling take up such a large portion of the visit, we have used time to determine level of service" for the follow-up visits, Walker explains.
If, however, your NPP injects the Interferon in the office, you should:
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