Wiki Head Lice Billing??

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ABridgman

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OK, so my doctor encountered a situation I have not yet encountered in billing, and I cannot seem to find a really clear answer here.

It seems Medicare "uses a different code to report this procedure" with regards HCPCS A9180 - Topical Treatment for head lice.

But I find no other CPT or HCPCS code that would be used. should I bill this simply as a normal focussed E/M visit, with the ICD code for lice infestation?

Please note this service occurred in a rest home/domiciliary setting, POS = 13 - and it affected the entire facililty...so I have a LOT of billing to do!

Some of these patients are Medicare, and some are not. I am not sure if commercial carriers pay on A9180, or if these also should be billed as the Medicare claims?

Help!!

thanks.
 
ABridgman said:
OK, so my doctor encountered a situation I have not yet encountered in billing, and I cannot seem to find a really clear answer here.

It seems Medicare "uses a different code to report this procedure" with regards HCPCS A9180 - Topical Treatment for head lice.

But I find no other CPT or HCPCS code that would be used. should I bill this simply as a normal focussed E/M visit, with the ICD code for lice infestation?

Please note this service occurred in a rest home/domiciliary setting, POS = 13 - and it affected the entire facililty...so I have a LOT of billing to do!

Some of these patients are Medicare, and some are not. I am not sure if commercial carriers pay on A9180, or if these also should be billed as the Medicare claims?

Help!!

thanks.
Click to expand...
but you are billing for the provider I assume. The question here is did your provider actually perform the treatment? Or just order the treatment. This is typically something the provider would diagnose and write an order for and the facility staff would execute the order. So the provider does not bill for the treatment, only the visit to diagnose the problem.
 
mitchellde said:
but you are billing for the provider I assume. The question here is did your provider actually perform the treatment? Or just order the treatment. This is typically something the provider would diagnose and write an order for and the facility staff would execute the order. So the provider does not bill for the treatment, only the visit to diagnose the problem.
Click to expand...

In this particular case, my provider both diagnosed and treated the problem. Like I mentioned, though, A9180 is not paid by medicare (and that HCPCS seems to cover only the actual treatment)

I am wondering if it is appropriate to bill a normal focussed E/M visit in this case.
This would be a 99213 in office, but in a rest care facility I believe it would be 99334. I have to double-check that right quick.

Yes, that was the code I wanted. 99334 is for established patients whereas 99324 is for new patients. Those are the codes for Focussed E/M Visit in a rest home. And I am wondering if, in this case, I should just bill the 99334 or 99324 as appropriate for each patient who was seen and treated.
 
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That HCPC II code is for the supply of the topical treatment which can then be applied by either the patient or the caregiver. It is not covered by Medicare and should be supplied by the facility. It is not a code for the actual application of the topical. The application is a part of the E&M. It is still interesting that the physician applied this treatment instead of a staff member, however it is just part of the treatment options for MDM.
 
mitchellde said:
That HCPC II code is for the supply of the topical treatment which can then be applied by either the patient or the caregiver. It is not covered by Medicare and should be supplied by the facility. It is not a code for the actual application of the topical. The application is a part of the E&M. It is still interesting that the physician applied this treatment instead of a staff member, however it is just part of the treatment options for MDM.
Click to expand...

So, billing the E/M procedure only is the correct coding...as I had thought? Nothing for the actual topical medicine, which should have been supplied to my doctor by the facility?

The application is a part of the E/M so, whether he applied it or THEY applied it...my physician did see and diagnose the patients - and in either case, billing the low E/M visit is correct...yes?
 
Thank you.

And I got clarification about what actually occurred...and I was mistaken about the doctor applying the treatment.

What happened was the doctor examined the patients for head lice, and confirmed the infestation.
The facility supplied and administered the topical treatment.
THEN, the doctor did a follup visit with each patient to determine the infestation had been eradicated.

When I got the billing from the doctor, there were two visits for each patient, and I had assumed one was for initial exam, the other for treatment...and I was incorrect.

Seems he withheld the billing from me until the followups had been completed, so the correct coding here is 99334 or 99324 for new patients...and two seperate dates for this on each patient, with a single diagnosis of 132.0

Thanks for the help...as I said, this was a situation I had not previously encountered.
 
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