AudCo2020!
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I am a CPC-A as of December 2015 and am proud and happy to say I have been working since January of 2016. First remotely for a few months and now I am working as a coder for a medical billing company. We bill for 18 different providers of various specialities and I get access to many different types of encounters. I have many questions in regards to what I have learned vs how it really works in the real world!
If a patient comes in for a B12 shot and does not see the physician what are the correct codes? I have been doing 96372 and J3420. Now I was initially coding 99211 with that as I was taught that is a nurse visit but then I read, on here somewhere I believe, not to bill 99211 w/injections. So which is correct?
Same scenario as above but patient does see the physician but nothing else is documented but the B12 shot; what are the correct codes for that? The same? Being that a complete office visit is not done or documented; just the B12 shot.
And on this note, when would you bill 99211? When will a patient come in only to see the nurse and not get an injection? Maybe a blood pressure check?
This one has me really stumped. A patient who broke his leg up north, had a cast put on up north, now home and wants a 2nd opinion. The provider sees this patient for the first time (weeks after the initial cast was put on; by another provider mind you) and sends him for X-rays and reads them immediately and fracture is healed so this provider removes current cast with anesthesia for cast removal, and applies another cast (not sure if this is a walking boot or what-waiting on more clarification from the office) and orders PT for patient. Is the cast removal, anesthesia, and new cast billable for this provider? This is the first time patient has seen this provider for the fracture.
On this subject of fractures, I would like some clarification on the initial encounter scenario. I have done a lot of research in regards to this but have found conflicting info. If a provider has not seen the patient before but is doing fracture care after the fact someone else has put the initial cast on is this considered an initial visit for the provider? Or is it if the patient has had any care prior, it was considered initial and all visits after are subsequent regardless of the provider seeing the patient for the first time or not?
Resolved vs resolving; I know as a coder we do not code a resolved condition. However, if patient is in for follow up of bronchitis and it is now resolved, do I code for the bronchitis again? That is why the patient is being seen and there are no other diagnoses with the visit.
Out of curiosity; how many providers are billing 99215? I have one who does his own E/M and he is fond of using 99215; too often I feel. But I was taught and what I have read about 99215 is it is a life threatening situation. Some examples of this please? That would be helpful to me and greatly appreciated. I provide E/M for another provider and on the flip side of this, I don't want to be undercutting it either.
In terms of chronic conditions and follow up visits for them: Note reads: Here for follow up ROS is done PE is done both are complete Assessment states only the conditions-some say controlled or at target most do not-sometimes it says things like bronchitis/pneumonia Plan states continue on current meds unchanged
I pull my hair out with this because my coder mind says nothing is clearly stated, conditions are not linked to the meds, and it seems nothing is codeable to me! Only conditions stated at target or controlled. Help with this would be greatly appreciated! And how about the one condition/another condition ??? Yes, I reread the note to see if it is stated elsewhere but what to do with a vs scenario?
I have also found in my short experience that providers do not like to be told how to document, and it is usually their MA's doing it anyways. I keep suggesting that I will be happy to put together info in regards to proper documentation and I have done a few things. But this is met with resistance from most of the providers.
I thank you in advance for info regarding my above questions. I want to code things as correctly and accurately as possible!
If a patient comes in for a B12 shot and does not see the physician what are the correct codes? I have been doing 96372 and J3420. Now I was initially coding 99211 with that as I was taught that is a nurse visit but then I read, on here somewhere I believe, not to bill 99211 w/injections. So which is correct?
Same scenario as above but patient does see the physician but nothing else is documented but the B12 shot; what are the correct codes for that? The same? Being that a complete office visit is not done or documented; just the B12 shot.
And on this note, when would you bill 99211? When will a patient come in only to see the nurse and not get an injection? Maybe a blood pressure check?
This one has me really stumped. A patient who broke his leg up north, had a cast put on up north, now home and wants a 2nd opinion. The provider sees this patient for the first time (weeks after the initial cast was put on; by another provider mind you) and sends him for X-rays and reads them immediately and fracture is healed so this provider removes current cast with anesthesia for cast removal, and applies another cast (not sure if this is a walking boot or what-waiting on more clarification from the office) and orders PT for patient. Is the cast removal, anesthesia, and new cast billable for this provider? This is the first time patient has seen this provider for the fracture.
On this subject of fractures, I would like some clarification on the initial encounter scenario. I have done a lot of research in regards to this but have found conflicting info. If a provider has not seen the patient before but is doing fracture care after the fact someone else has put the initial cast on is this considered an initial visit for the provider? Or is it if the patient has had any care prior, it was considered initial and all visits after are subsequent regardless of the provider seeing the patient for the first time or not?
Resolved vs resolving; I know as a coder we do not code a resolved condition. However, if patient is in for follow up of bronchitis and it is now resolved, do I code for the bronchitis again? That is why the patient is being seen and there are no other diagnoses with the visit.
Out of curiosity; how many providers are billing 99215? I have one who does his own E/M and he is fond of using 99215; too often I feel. But I was taught and what I have read about 99215 is it is a life threatening situation. Some examples of this please? That would be helpful to me and greatly appreciated. I provide E/M for another provider and on the flip side of this, I don't want to be undercutting it either.
In terms of chronic conditions and follow up visits for them: Note reads: Here for follow up ROS is done PE is done both are complete Assessment states only the conditions-some say controlled or at target most do not-sometimes it says things like bronchitis/pneumonia Plan states continue on current meds unchanged
I pull my hair out with this because my coder mind says nothing is clearly stated, conditions are not linked to the meds, and it seems nothing is codeable to me! Only conditions stated at target or controlled. Help with this would be greatly appreciated! And how about the one condition/another condition ??? Yes, I reread the note to see if it is stated elsewhere but what to do with a vs scenario?
I have also found in my short experience that providers do not like to be told how to document, and it is usually their MA's doing it anyways. I keep suggesting that I will be happy to put together info in regards to proper documentation and I have done a few things. But this is met with resistance from most of the providers.
I thank you in advance for info regarding my above questions. I want to code things as correctly and accurately as possible!