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Answer: There are two schools of thought. One is that you should use the diagnosis code for the initial problem the UTI. The other is that you should use V67.9 (unspecified follow-up examination). The initial-diagnosis school holds that the reason you are seeing the patient is a specific reason: the UTI. To bill for this visit, however, you must do more than just a urinalysis, even if you are only billing a 99211 (nurse visit). You must document a chief complaint, take a history and have an assessment plan. The argument for billing V67.9 is that if the condition is resolved, you cannot use the diagnosis code. Payers do not always reimburse V codes; thats why some coders prefer to use the initial diagnosis code.
The best code may be the same diagnosis as for the first visit, such as 599.0 (urinary tract infection). This followup visit is for further study to evaluate the presence or absence of the infection. Code 599.0 can be used until completion of the care for the current condition. Physicians believe they are treating something until the treatment is completed. The additional followup visit is to assess the disease process. Once you determine that there is no infection, if you bring the patient back again to see if the infection returned, that second followup visit is preventive, and Medicare wont pay for it.
Medicare carriers seldom pay for V codes, and even many HMOs, which espouse prevention, do not. Medicare has no policy on rechecks; some HMOs do. Since HMOs are in favor of prevention, they should pay using V67.9. If they dont, and the claim is denied, you may be able to bill the patient for the visit, depending on the HMOs guidelines for balance billing to a patient.
The ICD-9 code tells the payer why the patient is being seen. Medicare considers a visit to be medically necessary when the patient is seen for a complaint of a sign and/or symptom for a known condition, or because the physician recommended a return visit. In the case of a patient complaint of a sign and/or symptom, if the physician does diagnose a specific medical condition, use that diagnosis code instead of the symptom code. Medicare covers services that are medically necessary, shown by the reason for the visit. If the reason for the UTI recheck was to ascertain that the problem had resolved completely, the diagnosis is still UTI.
Beyond the diagnosis code, remember that you must do more than a urinalysis to bill an E/M service for this visit. The urologist must document a chief complaint, take a history and have an assessment plan.
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