Revenue Cycle Insider

Hint: Remember to add supplementary testing codes when necessary.

Now that children have returned to school nationwide, you have most likely seen an increase in office visits due to illnesses and conditions that are readily transmitted among children in classroom settings.

How well are you prepared for coding these common back-to-school ailments? Assess your knowledge by reviewing the scenarios below to find out.

Are You Ready for Ringworm?

Scenario: A 15-year-old high school wrestler came to see Dr. Manny, the family physician, after noticing a red, circular rash on their arm. The rash was itchy and had a slightly raised, ring-like appearance. The patient mentioned they first noticed the rash a few days after their most recent wrestling match. Dr. Manny got more details about their symptoms and recent activities. The patient mentioned that they often share equipment and wrestling mats with the other teammates.

Dr. Manny, suspecting the patient might have contracted ringworm, a common fungal infection, especially among athletes who have close physical contact with others, examined the rash closely and decided to take a skin scraping to be sent to the lab for a fungal culture. Pending the lab results, an antifungal cream was prescribed for them to apply to the rash, and the patient was advised to keep the area clean and dry.

The doctor also recommended the patient inform their wrestling coach about the situation so that the mats and shared equipment could be properly cleaned to prevent further spread of the infection. A follow-up appointment is scheduled in two weeks to check on the patient’s progress and to discuss the lab results. Overall, Dr. Manny spent 37 minutes with the patient.

Code the visit: For this office visit, an evaluation and management (E/M) code of 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.) would be appropriate when coding because of the amount of time spent with the patient.

For the skin scraping, you will use code 87220 (Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies)).

The ICD-10-CM code will be B35.4 (Tinea corporis) for ringworm of the body.

Nits the Mystery of This Head Lice Visit

Scenario: Dr. Ami saw a 7-year-old established patient and their parent, who had noticed the child scratching their head excessively over the past few days and found tiny white specks in the child’s hair. During the visit, the patient’s parent mentioned the constant scratching and white specks, which they suspected might be lice eggs. Dr. Ami then examined the patient’s scalp using a light and magnifying glass and confirmed that they did have head lice.

Dr. Ami then prescribed a medicated shampoo for the patient to use along with thorough instructions. Advice was also given on how to clean their home and laundry to prevent the lice from spreading or recurring.

Code the visit: For this visit, an E/M code of 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.) is appropriate.

Additionally, the correct ICD-10-CM code is B85.0 (Pediculosis due to Pediculus humanus capitis) to indicate a head-louse infestation.

Rapidly Conclude This Strep Throat Case

Scenario: Dr. Johnson, a family physician, had a scheduled appointment with a 12-year-old patient whose parents had noticed that the child had a high fever and sore throat for the past two days. During the visit, Dr. Johnson asked about the patient’s symptoms and how long they had been feeling unwell. The patient mentioned that their throat was very sore and that swallowing was painful. The child also complained of a headache and stomachache. Dr. Johnson proceeded to examine the child’s throat, noting the redness and swelling. The patient’s temperature was also elevated.

Given the symptoms, Dr. Johnson suspected strep throat to be the cause and decided to perform a rapid strep test. The test came back positive. A course of antibiotics was prescribed to treat the infection, and the patient was advised to rest, stay hydrated, and avoid contact with others until no longer contagious.

Code the visit: For the office visit, E/M code 99213 would be appropriate here. For the rapid strep test, you would choose 87880 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A). Additionally, you would use ICD-10 code J02.0 (Streptococcal pharyngitis), which is the medical term for strep throat.

Scratch Your Way Through This Scabies Situation

Scenario: Dr. Lee, a pediatrician, had a new 6-year-old patient brought in by their parent. The parent had noticed a rash on the child’s arms and legs that had been causing them major discomfort, especially at night when trying to sleep. During the visit, Dr. Lee asked the patient and their parent about the symptoms, and when they first noticed them. Dr. Lee proceeded to examine the child’s skin, noticing the telltale signs of a scabies  infestation — a pimple-like rash and signs of scratching. The doctor explained to the patient and parent that scabies is caused by tiny mites that burrow into the skin, causing an allergic reaction and intense itching.

A topical cream was then prescribed to the patient, and Dr. Lee provided instructions on how to apply it. The practitioner also gave them advice on how to deeply clean their home and advised that they wash their clothes and bedding to prevent the mites from spreading or recurring. A follow-up appointment was scheduled in two weeks to ensure the treatment was effective.

Code the visit: Because this was a new patient, you would choose E/M code 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.).

You would also choose ICD-10-CM code B86 (Scabies).

Make note: Had the practitioner needed to test a skin sample of the patient to confirm the diagnosis, you would need to add CPT^® code 87220 to your claim.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC