A patient that recently had a hysterectomy presented to the ED with symptoms needing treatment. The physician noted that the patient was suffering from “estrogen withdrawal with menopausal symptoms.” A level three evaluation and management service was performed on the patient; what diagnosis code would you use? There’s no specific code for estrogen withdrawal.

Stumped? In this case you should use more than one code as there is no specific code for this service. Break out the claim to show the patient’s main complaint and reason for the ED visit and then to show that she is a recent hysterectomy patient.

You will want to report code 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M service. Then you will want to pair that coding with 627.4 (Symptomatic states associated with artificial menopause) to 99283 to represent the patient’s estrogen withdrawal. Then, to back up the history of patient by attaching V45.77 (Acquired absence of organ; genital organs) to 99283 to signify that the patient had a hysterectomy.

Good documentation will show that this patient had a legitimate need for treatment and management and you are more likely to receive reimbursement for your medical billing claim if you meet this criteria.

If you’re wondering if there is a single code, the answer is yes. A parent conference falls under V65.19 (Other persons seeking consultation; other person consulting on behalf of another person). In other words, the code describes a person seeking “advice or treatment for non-attending third party.” Since a parent has the right to discuss the treatment and medical issues for their minor child it’s per missable to bill for the consultation.

The counseling diagnosis code can be used when the patient is present or when counseling the parent/guardian(s) when the patient is not physically present as in over the telephone. Although carriers may require supporting documentation for coverage of the encounter, so make sure you indicate the discussion’s topic and the documentation should be signed off on by the attending physician. In case of an as yet undiagnosed concern, you can also check if payers want a secondary diagnosis that indicates the topic.

There are numerous reasons for consultations that include these top four common reasons:

• ADD/ADHD — 314.00, Attention deficit disorder; without mention of hyperactivity; 314.01, Attention deficit disorder; with hyperactivity
• anxiety — e.g., 300.00, Anxiety state, unspecified
• depression — e.g., 311, Depressive disorder, not elsewhere classified
• obesity — 278.00, Obesity, unspecified.

Use the total face-to-face time that the pediatrician spends with the parents to select the service code. Careful supporting documentation of the time elements is critical and will result in reimbursement for your medical billing claim.

The answer to this question will be different depending on which entity is paying the medical billing claim. When you code for the use of tissue adhesives, including Dermabond; Medicare has its own guidelines for reporting this procedure that you need to follow to be reimbursed. You should report G0168 for Medicare patients only. If you are reporting the procedure for a non-Medicare patient, you should use the CPT code that is the equivalent and that is 12001-12018 series (Simple repair of superficial wounds …). 

Another tip for reporting this claim to Medicare is you may only use G0168 for Dermabond-only laceration repairs in both the inpatient and outpatient settings. If sutures or staples were also used you will have to report this as a layered laceration code on your medical billing form.

Something you may not be aware of is that Medicare assigns a payment status indicator of “N” to G0168, meaning it represents an incidental service. You can report the code but you won’t receive any reimbursement for it from Medicare payers.

Private payers will have different guidelines, a quick check with the payers to see if they follow Medicare guidelines for this type of procedure will let you know whether or not to expect a reimbursement for the service.

Colonoscopies are part of a check up for most individuals over the age of 50, however when the colonscopy finds a polyp, you should normally use the polyp diagnosis in your medical billing claim and not the screening V code. The exception to this rule would be if the physician discovers a polyp during the screening, you should instead report a diagnostic colonoscopy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple). 

The coding changes for a situation where the surgeon visualizes and biopsies the polyp, you should change the primary diagnosis from V76.51 (Special screening for malignant neoplasms; colon) to, for instance, 211.3 (Benign neoplasm of other parts of digestive system; colon).

The majority of carriers have states they want to switch the polyp diagnosis for the excision a few want to keep the V code. If you’re not sure in your medical billing, avoid a delay or rejection by asking what the carrier’s preference is.

One important thing to learn is when you should also list a diagnosis code for the wound in I3. The I3 is important to complete when you’re doing medical billing for long term care patients as it reports additional conditions that affect a patient’s health. 

Since pressure ulcers are extremely common in long term care for patients that are invalids, there is a Section M that provides options for identifying both pressure ulcers and stasis ulcers but not for other types of ulcers. If another type of ulcer is to be reported on your medical billing claim, use the form and then also list the corresponding ICD-9 codes at I3, says Smith. In this case, you should list:

A confusing part of medical billing for long term care comes from the I3 itself where some I3 coding training indicates that you don’t need to include diagnoses codes for conditions that are addressed elsewhere on the MDS. However, many carriers, including Medicare do require that the type of wound be specifically spelled out. Additionally, once the ulcer is healed, be certain to take it out of section I3.

A common situation would be if the ED physician performed a diagnostic nerve block on a patient complaining of pain in the floor of her mouth and her bottom set of teeth. You would want to be certain that you chose 64402 (Injection, anesthetic agent; facial nerve) for facial nerve blocks, not blocks in the mouth or jaw. The determining factor is that the surgeon treated a branch of the trigeminal nerve, not the facial nerve. 

On the claim, report 64400 (… trigeminal nerve, any division or branch) for the nerve block. Other 64400 scenarios: Areas affected by the trigeminal nerve and its branches, and therefore coded with 64400 for nerve blocks, include:

• the body of the mandible and the lower portion of the ramus
• upper and lower teeth
• floor of the mouth
• anterior two-thirds of the tongue
• gingiva on the lingual surface of the mandible
• gingiva on the labial surface of the mandible
• mucosa and skin of the lower lip and chin.

To ensure proper payment, back up your medical billing claim with the proper documentation to show the reason for the facial or dental block and that will allow the carrier to see why this code was chosen along with the necessity of the procedure. This will enable you to realize reimbursements instead of rejections on these type of claims.

In medical billing, the place of service codes for an evaluation and management are commonly misused. There are several current procedural terminology codes for an evaluation and management session that correspond to different medical billing place of service codes. When using CPT 99341 (Home visit for the evaluation and management of a new patient) through 99350 (which means the same as 99341 except with an established patient), the only POS code available for use is 12. This means home.

Many billers get confused with these medical place of service codes. If a patient is in an assisted care center, many people consider this a home and bill with place of service code 12. This would be incorrect. POS 12 is reserved for house, apartments, etc visits. There is actually a more specific code for an assisted care center in medical billing, the correct POS code would be 13.

Basically, for every current procedural terminology code, there is a correct place of service code that corresponds to it. if these medical codes are used incorrectly in billing, it will cost your practice time and money. Insurance companies will deny the claims and your office will have to correct the problem. With the use of an outside medical billing company, you can erase this problem from your mind. Medical billing companies are versed in the correct billing procedures for every medical service. They check claims for accuracy before they are submitted and take care of any claims that come back unprocessed. Correct medical billing POS codes are essential for maximum practice profitability.

Many times, a physician will end up seeing a patient that shows up in search of a visit to fall into the category of preventative medicine. Then, upon further evaluation, the doctor will then need to look at the patient further for some sort of significant problem that they have. As a coder, you may end up finding yourself in a situation where you are not sure if you are to code the visit under a new or established patient. 

This type of a situation definitely calls for a swift bit of judgment on your part. In order to make sure that the practice receives reimbursement and avoids denial, you can always go with a new patient code to begin with. Then, after you look through and take all of the medical documentation into account, you can see if there is a modifier that you can add on.

No matter what you decide on when coding in such a predicament, you need to realize that you can come into problems with insurers. Always take the procedure, documentation and time lapse between visits into account before you record the code.

Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments.

On the claim you would want to report 24600 (Treatment of closed elbow dislocation; without anesthesia) for the elbow reduction. Then attach ICD-9 code 832.03 (Dislocation of elbow; closed; medial dislocation of elbow) to show the reason for the reduction) and then add the modifier 52 (Reduced services) to 24600 to show that you are not reporting a fully successful reduction.

Some physicians may choose not to bill at all for a painful procedure that isn’t successful however do include the medical necessity and documentation of the procedure to show the reason for another or more expensive procedure.

Cover yourself and make sure all your medical billing claims are thoroughly documented, this will result in better reimbursements and airtight claims from your practice and you’ll reap the rewards of a better revenue flow for your business.