Report 456 for On-Site Urgent Care
Question: If our urgent care area is separate from the emergency department (ED) and open only 12 hours a day, what revenue code and what CPT codes should we use to report urgent care visits? Is revenue code 456 (Urgent care) appropriate in these situations, and should we report codes from the series 99201-99205?
North Dakota Subscriber
Answer: Since you can only use the 99281-99285 code range in an emergency department open all the time (24 hours, 7 days a week), codes from the 99201-99205 and 99211-99215 ranges would indeed be appropriate for such urgent care services.
You should generally bill them with revenue code 456 (Urgent care) or 516 (Urgent care clinic) - the latter is usually reserved for off-site settings or those not directly associated with the emergency department.
Question: A patient presents in the hospital with acute respiratory failure. The doctor must obtain biopsies from the patient's lungs to diagnose the problem. Because the patient is having respiratory failure, an open lung biopsy isn't an option. Therefore, the physician performs a transbronchial lung biopsy with the help of fluoroscopic guidance to navigate the forceps to the upper lobe of the lung. How should I report this?
South Carolina Subscriber
Answer: You should code the bronchoscopy with transbronchial biopsy as 31628 (Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy[s], single lobe). If the physician must also take a biopsy from another lobe in either lung, you report this as +31632 (... with transbronchial lung biopsy[s], each additional lobe [list separately in addition to code for primary procedure]) to indicate an additional biopsy from a different lung lobe.
Keep in mind that for both 31632 and +31633 (... with transbronchial needle aspiration biopsy[s], each additional lobe [list separately in addition to code for primary procedure]), you can only report each code once per lobe, regardless of how many transbronchial lung biopsies or needle aspirations the physician performs in that lobe, CPT states.
Question: What is the difference between the two codes for clearing an obstructive vascular catheter - 36595 and 36596?
Texas Subscriber
Answer: Basically, which code you should report depends on whether the obstructive material is inside or outside the patient's catheter. For removal of outside material, you'll report 36595. For removal of inside material, you'll report 36596.
CPT added codes 36595 (Mechanical removal of pericatheter obstructive material [for example, fibrin sheath] from central venous device via separate venous access) and 36596 (Mechanical removal of intraluminal [intracatheter] obstructive material from central venous device through device lumen) two years ago to reflect the work involved in removing catheters with fibrin sheaths.
Question: To report an ICD-9 code from the 393-398 series, does the physician have to state "rheumatic" in the documentation?
West Virginia Subscriber
Answer: Yes, you should definitely see "rheumatic" in the documentation if you're going to report a code from the 393-398 series (Chronic rheumatic heart disease).
When reporting valve disorder codes, your first step should be to find the problem's origin, because that will determine which code series you use.
Focus on the 393-398 series if the defect resulted from rheumatic fever - an inflammatory disease that begins with a strep throat infection and can cause several heart complications.
Tip: Remember that the "find the cause" rule has an important and confusing variant. Although the ICD-9 manual describes the 393-398 series as being for "chronic rheumatic heart disease," it specifies that you should use 396.x (Diseases of mitral and aortic valves) when the patient has problems with both the mitral and aortic valves, "whether specified as rheumatic or not."
- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
