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April 2013
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“Ask the Coder” Your Tough Coding Questions

Given the inherent subjectivity of picking the most appropriate current procedural terminology (CPT) service code, the answers provided through “Ask the Coder” are provided on an “as is” basis. Readers must use their own independent professional judgment in making coding decisions. The reader assumes all risks in using this information.

Have tough coding questions? The rules governing inpatient consultations, subsequent hospital visits, and prolonged services are complicated, and picking the appropriate CPT code level can be difficult.

“Ask the Coder” can help. This online resource was developed to help IDSA members and their office staff. If you have a question about evaluation and management (E&M) or CPT service codes, take advantage of this member benefit by filling out the form on the “Ask the Coder” webpage (member login required). Your question will be sent to a certified professional coder for a response.

Recent topics included coding for vaccinations and for preventive medicine counseling for travel clinic services.

One IDSA member recently asked, “How do we code vaccines for Medicare patients who need hepatitis B, pneumococcal, or influenza [vaccine]? For example, if a Medicare patient needs hepatitis B, is it appropriate to bill a V05.3, G0010, and a 90471? Or would we just bill a V05.3 and the G0010? We don't understand how to use the G codes.”

Ask the Coder: This PDF “has some additional information regarding appropriate vaccination coding. In your scenario, you did not include the code for the actual vaccine product; for hepatitis B, you should look at CPT codes in the 90739-90748 series. You should also bill the administration code for the vaccine. Medicare requires G0010 as the administration [code] for hepatitis B. Other insurance companies use the CPT administration code of 90471. The V code you referenced is an ICD-9 code.”

Another member asked about coding for preventive medicine counseling. “Code 99401 is used for counseling of approximately 15 minutes, and code 99402 is used for approximately 30 minutes,” the member noted. “Exactly where is the dividing line between the two codes? What is the minimum length of time needed for 99401? When would I use 99402 rather than 99401?”

The member continued, “This involves ‘travel clinic’ services. We discuss plans for international travel as well as the traveler’s immunization history and health status. Based on that, we provide recommendations for coping with traveler’s diarrhea and for preventing malaria. Also, we order immunizations. Because there is no exam (aside from vital signs), the entire physician-patient contact is devoted to counseling for the prevention of infectious diseases abroad.  Without an exam, I don’t believe we can use typical E&M outpatient codes, such as 99201, 99202, 99203, etc.”

Ask the Coder: “First of all, you certainly can use regular E&M codes that don't have much of an exam. Coding by time was meant for these situations. Document total time, counseling time, and what was discussed. Then choose the E&M level based on the total time.
“These special preventive medicine counseling codes, 99401 and 99402, are not payable by Medicare, and other insurance companies may or may not follow that policy. Since they are part of the E&M section of codes, I would say that you need to meet the threshold time as required in the code description.” 

You can submit your coding questions through the “Ask the Coder” webpage. Additional information about billing and coding is available at www.idsociety.org/Billing_and_Coding.
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