Field-Tested Advice

Simplify hormone stimulation tests with this coding strategy

In her office, they have a procedure sheet for hormone stimulation tests, says Cheryl Frey, a 20-year experienced coder and billing manager at Central Endocrine & Diabetes Consultants in Maitland, Fla. The nurse uses the procedure sheet to check off the components of each stimulation test, and then they code accordingly, she says. It's hard for a coder to piece the whole test together without clear documentation. The procedure sheet greatly facilitates the coding process because each test can vary depending on time requirements and what drugs and what quantities the physician uses.
 
Drawing up a set coding "recipe" sheet for each stimulation test would be impossible because there are just too many variables, Frey says.

The procedure sheet has slots at the top for the nurse to indicate the type of stimulation test, the physician's name, the  patient's name, weight, blood pressure, etc, Frey says. The sheet also lists infusion and injection codes, and medications with boxes, so the nurse can simply check off what is done and which supplies and medications the physician uses. After the test, the nurse transfers the information onto the superbill and then that goes to the coders, she adds.
List the Dosage for All Drugs
Coding for all the drugs involved in hormone stimulation tests is often the most complicated part. Each practice has its own drug preferences, so you may want to develop a separate charge slip that lists all the drug options with slots for the doctor to fill in the milligrams, Falbo says. In an audit, you will get your J codes downcoded to the lowest level if the physician hasn't documented the dosage, she says.
Choose Between J Codes and 99070
While Medicare now requires that you bill medications using J codes, there are some third-party payers that still use 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), Falbo says. You shouldn't just assume that all payers will accept J codes. You may want to check with each payer to see what's accepted before you write up a drug charge slip for your office.

You should also check with payers first before you bill for supplies using A codes, Falbo says. In many cases, the cost of the supplies is built into the reimbursement for the injection or infusion code.

- Published on 2004-03-12