Oncology & Hematology Coding Alert

Question: A mother brings her daughter in for her four-year-old follow up after chemotherapy. Our oncologist performs the well child check-up. During the encounter, the mother states that the patient has been having congestion and headaches. The physician documents an expanded problem-focused history and exam with a low complexity MDM related to the problem. The diagnosis is a sinus infection. Can I report both visits?

Georgia Subscriber

Answer: Yes. You can report the problem-oriented portion of the visit with 99213 (Office or other outpatient visit…) with a diagnosis code of J01.90 (Acute sinusitis, unspecified).

Then, you can also report 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual…) for the well child check-up with diagnosis code Z00.129 (Encounter for routine child health examination without abnormal findings). Attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99213 to indicate the payer should reimburse you separately for these services.

Remember: Often the differing diagnosis code you report will help prove medical necessity to the payer.

Tip: Check the diagnosis codes your physician is noting. Speak to your doctors to help them write complete and concise notes that support all their procedures, services and the medical conditions (reasons) the services were provided.