Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 26, 2010 PDF

Also: Keep incident-to rules in mind when NPP performs the service.

Question: A 68-year-old established Medicare patient reports to the office for a visit stemming from a recent auto accident he was in; he ran off the side of the road at low speed, then overcompensated and hit another car.

Answer: The ICD-9 manual includes a V code that may prove medical necessity for this visit.

On the claim, report the following:

• 99212 -- Office or other outpatient visit for the evaluation and management of an established patient... -- for the E/M

• V71.4 -- Observation and evaluation for suspected conditions not found; observation following other accident -- appended to 99212 to represent the reason for the visit

• E811.0 -- Motor vehicle traffic  accident involving reentrant collision with another motor vehicle; driver of motor vehicle other than motorcycle -- appended to 99212 to represent the type of accident that occurred.

Exception: The above coding assumes that the patient was not driving for his employer when the accident occurred. If the patient had the accident on the job, report V71.3 (... observation following accident at work) instead of V71.4.

Please be aware that these diagnosis codes on the claim may prompt the Medicare contractor to send you a questionnaire to collect information on the existence of other insurance that may be primary to Medicare (for example, the patient's auto insurance) in this situation.

Consequently, you may want to inquire with the patient at the time of the visit if he is taking any action (such as filing a claim with his auto insurance) in conjunction with the services the internist provides.

Important: You must bill the encounter under the NPP; as this is a new problem, the incident-to rules do not apply.

Also, if auto insurance is involved, you may need to file the claim with the auto insurance carrier, or at least contact the company to ask about their policy and procedures.