Pulmonology Coding Alert

Handy tool helps keep charge ticket updated and the auditor at bay

There's no question that a well-designed charge ticket keeps any practice on top of its game, but if you don't have all of the elements covered, your practice won't reach "super" status.

As a new generation of codes affects practices in 2005, let our experts walk you through a few design and content tips that will ease the growing pains of your coding process and decrease the easy-to-avoid denials your practice may face:

Use the most current ICD-9, CPT and HCPCS codes:

Update CPT and HCPCS annually, AT LEAST

Update CPT during the fall when the bulk of the new codes come out.

Update ICD-9 twice per year: April and October

List the complete range of E/M codes:

Try placing your E/M codes in three different categories.

Identify estimated face-to-face time for each code in case the physician reports counseling/coordination of care time:

- New patient (99201-99205)

- Established patient (99211-99215)

- Outpatient consults (99241-99245)

Make sure you don't miss any other important code categories such as:

Office procedures (e.g., oximetry walking, spirometry)

Laboratory (e.g., sputum culture, hypersens. pneumo. profile)

Allergy/skin testing (e.g., one injection [allergy], intradermal)

Injections (e.g., pneumovax, therapeutic)

Drug codes (for allowable injectibles)

Panel (e.g., thyroid, lipid profile)

X-ray (e.g., chest [single], chest [PA/lateral])

Miscellaneous (e.g., sleep diary, smoking cessation consult, insurance forms [extensive or limited])

Include any scheduled procedures with documentation of:

when the patient should return

function studies

pulmonary rehab/consults

stress test information

echocardiograms

polysomnogram

ultrasound

Next time: Whom is the appointment with, what does the patient need in the next appointment, and when is the next appointment?

Don't miss: DIAGNOSIS(ES) - and they have to match the procedure

Extra essentials:

Insurance information (policy ID, relationship to insured, prior balance, today's charge, adjustments, today's payments, and BALANCE DUE)

Patient demographics (i.e., name, doctor, responsible party)

Never forget the physician's signature for any additional notes or comments and the patient's signature for insurance benefit authorization.

On the flipside:

Keep an alphabetized list of all the ICD-9 codes your practice commonly uses on the back of your charge ticket. Editor's note: Information in this instrument was  provided by Theresa M. Scott, CPC, account receivables manager with Cabarrus Lung Associates in Concord, N.C.