Wiki CPT code 95044

[NESmith]

Good Morning.
Please help me with these question on this CPT code.
1. Does the MD/ARNP have to be present (in the room) for the initial placement?
2. Can MD/ARNP bill for an office visit with the initial placement?
3. Can the nurse only read the interim visits?
4. Can we charge a nurse only visit for the readings?
5. Can we charge for an office visit for the final analysis?

Thank You for you help with these questions.

 

[amberpurdy]

1. Does the MD/ARNP have to be present (in the room) for the initial placement?

No

2. Can MD/ARNP bill for an office visit with the initial placement?

If the Dr sees the pt for the contact dermatitis, decides to do a patch test and has the nurse apply it that visit you can code the office visit but if the pt has to come back to have the patch test applied (often this is needed since it has to be read at certain intervals so you can't apply it on a Thursday or Friday) then the nurse would apply the test and the only billable charge for that day would be the patch test itself.

3. Can the nurse only read the interim visits?

Yes the nurse can read the 1st reading.

4. Can we charge a nurse only visit for the readings?

No because there is no evaluation and management done so the 99011 does not apply. While it is not a global it should be billed similar to a global, it would be a No charge visit and no copay would be collected.

5. Can we charge for an office visit for the final analysis?

Yes at the final reading and analysis visit the Dr or NP would read the final test, interpret the results from both readings, determine what the pt is allergic to and develop a treatment plan for managing the pt's allergy or sensitivity. It would qualify as an office visit and would be coded accordingly.

Our Doctor would like to be able to bill the pt for the 1st reading and we have researched it almost every year for the last 4+ years and the conclusion of AAPC and everything we can find is that it is not billable. I personally think that is fair since the test is charged per the # of allergens tested and the pt has an E/M visit before the patch and after the test so the total of all billable charges winds up being around $600.

The one that I think we should be able to bill for is applying squaric acid to pt's to develop their sensitivity to it so they can treat their warts at home with squaric acid. We do an E/M visit and apply the first application of squaric acid and then have the pt come back in a week for another application and repeat as needed until the pt has a reaction. Each time they come in for the nurse to apply the acid it ties up nurse time and a room but because their is no code for the application of squaric acid and there is no E/M done we can't bill an office visit or a procedure code so it is a No Charge visit. I think we could bill a J code for the squaric acid we use but it is such a small amt it doesn't really fit a J code. Anybody else handle it differently?


Amber L. Newcomb, CPC
Biller and Coder in a Dermatology practice for 4+ years

 

[NESmith]

Thank You Amber. This information is great.