Primary Care Coding Alert

Once you’ve answered the quiz questions on page 3, compare your answers with the ones our experts have provided below.

Answer 1:
In Primary Care Coding Alert v20n11, we discussed the deletion of 11100/+11101 (Biopsy of skin, subcutaneous tissue and/or mucous membrane …) and the addition of six new biopsy codes: 11102/+11103 (Tangential biopsy of skin …), 11104/+11105 (Punch biopsy of skin …), and 11106/+11107 (Incisional biopsy of skin …).

When we reported this, we also discussed the added specificity that the new codes brought to biopsy coding. Rather than describing the procedure by highlighting the depth of the skin from which the tissue sample was taken, the new codes now give you the chance to actually describe what your provider did, whether it be a tangential, or superficial, biopsy; a punch biopsy, which takes a full-thickness cylindrical samples from the subcutaneous skin layer; or an incisional biopsy, which uses a scalpel to go deeper into the skin.

The change is significant and clears up confusion over the way the provider performed the procedure. “The skin biopsy codes have always been a bit unclear in that regard, because they always seemed to me to imply a punch biopsy,” said Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. “The new codes will allow more specific pricing and will make it clearer what was done.”

Answer 2:
In Primary Care Coding Alert v20n9, we reported that, effective July 1, 2018, 99172 (Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination[s] for contrast sensitivity, vision under glare)), 99173 (Screening test of visual acuity, quantitative, bilateral), and 99174 (Instrument-based ocular screening (eg, photo screening, automated-refraction), bilateral; with remote analysis and report) would no longer be paired with 99381-99397 (Initial/Periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new/established patient) as procedure-to-procedure (PTP) edits.

At the time, we noted that this decision was consistent with CPT^® guidelines regarding preventive medicine services, which state that “Vaccine/toxoid products, immunization administrations, ancillary studies involving laboratory, radiology, other procedures, or screening tests (eg, vision, hearing, developmental) identified with a specific CPT^® code are reported separately.” The guidelines “speak specifically to the important distinction of these services as payable with well care. Continuing to maintain the exclusion would be antithetical to preventive care ideals,” said Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC, when the edits were announced.

Answer 3:
In Primary Care Coding Alert v20n8, we introduced you to eight new additions to the ICD-10 Z13 screening codes. You can now report Z13.30 (Encounter for screening examination for mental health and behavioral disorders, unspecified), Z13.31 (… screening for depression), Z13.32 (… screening for maternal depression), and Z13.39 (… screening examination for other mental health and behavioral disorders).

Additionally, four other codes now describe screenings for childhood developmental disorders: Z13.40 (Encounter for screening for unspecified developmental delays), Z13.41 (… autism screening), Z13.42 (… screening for global developmental delays (milestones)), and Z13.49 (… screening for other developmental delays).

Like the addition of the CPT^® skin biopsy codes, these new ICD-10 codes add more specificity to your reporting than was previously possible. “Prior to implementation of these codes, a provider would have just selected the symptom and/or a less specific screening code to communicate the service provided, which often results in a request for medical records and a delay in payment,” said Sherry Wright-Fontenot, CPC, CPCO, CPMA, CEDC, AAPC Fellow, revenue integrity analyst at St. Luke’s Health System in Kansas City, Missouri, when the codes were released.

Now, however, “these new screening codes will help the providers better communicate the type of visit or service they are providing to patients and, hopefully, create a positive impact for our providers’ reimbursement,” according to Wright-Fontenot.