Primary Care Coding Alert
Using 2 ICD-9 Tips to Get Paid for 95930 and E/M
Careful: Sometimes a well-check diagnosis isn't the way to go You-ll get paid the first time around for visual evoked potential (VEP) tests if you use the payer-required V code and switch to a problem code when you should. 1. Track V Code Requirements Because physicians often perform VEP during a preventive pediatric medicine service, you-ll link 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash) to one of two V codes. On your VEP tracking sheet, note a payer's requirement of either ICD-9 code: - V20.2 -- Routine infant or child health check - V80.2 -- Special screening for neurological, eye and ear diseases; other eye conditions. Most insurers cover the test during the well check with the preventive medicine service diagnosis. "Many commercial plans, as well as Aetna, accept V20.2 on the vision screening and on the preventive medicine service," says Diane C. Fulton, director of insurance/medical coding and billing for Diopsys Inc. in Pine Brook, N.J. "Technically, V80.2 is a better code to use with 95930 because the specific V code describes why the provider is doing the procedure," Fulton says. Some health plans bundle screenings codes with V20.2. Therefore, a different ICD-9 code from the preventive medicine service's V code (V20.2) will show that the screening is a separate and identifiable procedure from the well visit (99381-99385 for new patients, and 99391-99395 for established patients). Example: At a 3-year-old's established patient preventive medicine service, the FP orders a nurse to test the child's vision using the VEP machine. The test shows the child has no functional asymmetries. On the claim, you report: - 99392 (Periodic comprehensive preventive medicine reevaluation and management of an individual - early childhood [age 1 through 4 years]) for the preventive medicine service - 95930 for the VEP test - V20.2 linked to 99392 - V80.2 linked to 95930 (V20.2 for Aetna). 2. Default to Problem Diagnosis When Found Make sure you use the V code only when the screening is negative. When the test reveals a problem, switch to the problem diagnosis. Example: A mother brings in her 6-year-old son. She's worried he may have learning disabilities because his teacher says he's not reading at the same level as his peers. A nurse administers a Conner's developmental test (96110, Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) that the FP interprets as showing no problems. The FP then has a nurse screen the child's vision with the VEP machine. The test shows a positive result: There are differences in each eye's response. The FP reports a level-four office visit, which the coder enters on the CMS-1500 form with: - Dx 1: V71.89 (Observation and evaluation for other specified suspected conditions) - Dx 2: 794.13 (Abnormal VEP). Procedure, Services Diagnosis Pointer 1. 99214 (office visit) 1 2. 96110 (Conner's test) 1 3. 95930 2. If the child tested normal (negative), you would bill 95930 with the condition, sign or symptom that prompted the test and V80.2.
Primary Care Coding Alert
- Use Inside Info to Prevent HPI Rule Hunt
In CMS's eyes, this element is your FP's duty Although support staff might want to [...] - Risk Audit by Coding Same-Date E/M, Critical Care
Heed this warning: Medicare mentions -discretionary reviews- on 99291 claims You-ll need to be sure [...] - Clean Up 99291 Claims by Keeping Up With Transmittals
Medicare now excludes critical care and an ED E/M on same date CMS has released [...] - You Be the Coder:
Complex or Simple Nosebleed Treatment?
Question: An established patient reports to the FP with a bleeding left nostril. She tells [...] - Pediatric Coding Corner:
Using 2 ICD-9 Tips to Get Paid for 95930 and E/M
Careful: Sometimes a well-check diagnosis isn't the way to go You-ll get paid the first [...] - Reader Questions:
Include Anesthesia in 1 Circ Type
Question: When an FP performs a neonatal circumcision without anesthesia, a consultant said I should [...] - Reader Questions:
Code Differently for 'Alterations' and 'Blackouts'
Question: A 25-year-old new patient reports to the FP for his initial visit. He says [...] - Reader Questions:
ICD-9 Code Choice Depends on Apnea's Cause
Question: The physician performs a level-two E/M on a new patient with sleep issues. The [...] - Reader Questions:
Freeze at 327.XX ICD-9 Section for Sleep Paralysis
Question: An established patient reports to the FP reporting that shortly after waking up in [...] - Reader Questions:
If Physician Makes No Incision, Opt for E/M
Question: A patient presents to the FP with shards of glass from a shattered light [...]
