Medical coding for Family Practice involves coding for a variety of procedures ranging from vaccinations, injections, and immunizations to multiple procedures. Family physicians provide a range of acute, chronic and preventive medical care services, diagnosing and treating illnesses, conducting routine checkups, screening and immunization tests and even providing advice on maintaining a healthy lifestyle. To obtain the correct reimbursement, physicians should know how to determine the level of history, exam and medical decision making. They should also know to determine the right level of service provided. Other aspects that demand a comprehensive knowledge include the various regulations of Medicare with regard to consultations, teaching situations, shared visits and global surgery.
Family Practice Codes Most Frequently Used
• New patient office visits(99201- 99205)
• Established patient office visits – (99211- 99215)
• Hospital visits – (99217- 99239)
• Other codes for labs, procedures
Family physicians have to be careful in selecting a level of evaluation and management services. The main components to consider while selecting include the history, examination and making a medical decision. However, it is important to bear in mind that all these three components are required in the case of new patient visits and initial care provided in a hospital or nursing facility, but only two are required for follow up care. The nature of a visit and the setting in which the E/M service is provided decide whether two or three key components are required to signify the level of service.
• For services provided in the office for a new patient, all three key components are required, while for an established patient only 2 key components are required.
• Three key components are required for a new patient visit at home/domiciliary facility, whereas only 2 of these are required for an established patient.
• Three key components are required for a comprehensive assessment in a nursing home, and 2 key components for subsequent care provided.
• For services provided in a hospital, three key components are necessary for initial hospital care, initial inpatient consultation and observation services; 2 key components are required for subsequent care and follow-up inpatient consultations.
• For services provided in the Emergency department all 3 key components are required.
Code Correctly for Consultations and Prolonged Services
Another important fact with regard to family practice medical coding is that practitioners should code correctly for consultations and prolonged services. Consultations receive higher reimbursement compared to routine office visits and initial hospital visits or subsequent care provided in hospitals. Every request for consultation has to be correctly documented.
• Codes 99241 – 99245 for office/outpatient consultations
• Codes 99251 – 99255 for initial inpatient consultations
Prolonged service codes are to be reported when you spend more time than the usual for providing a particular service. These codes are in the range (99354-99359). This time can be either face-to-face time or the time before or after the face-to-face time.
Let us look at some other procedures carried out in family practice offices:
• Arthrocentesis, major joint or bursa – 20610, to be reported with modifiers -RT, -LT or 50 (bilateral)
• Hot/cold pack – 97010
• Impacted ear wax removal – 69210
• Skin biopsy – 11100
• Spirometry – 94010
• Destruction lesion, benign – 17110
• Injection Tendon sheath/ligament/cyst – 20550
• Percutaneous allergy skin tests – 95004
• Influenza virus vaccine, age 3 and over, intramuscular – 90658
• Electrocardiogram, with interpretation and report – 93000
• Chest X-ray – 71020
Family practitioners need to be very thorough with the laboratory and immunization codes that change from year to year.
Coding for Injections
Family physicians can bill for injections using an HCPCS code (if it is a drug/biological) or a CPT code (if it is a vaccine). Medicare reimbursement for the service would depend on whether the injection is incidental to the visit or whether it is the main purpose of the visit. However, some private payers reimburse for a low level E/M visit even when the main purpose of the visit is the injection.
Understand What Modifiers Stand for
Modifiers are to be used along with the appropriate CPT codes to signify additional explanation of the services provided. Family Practice modifiers include:
• -25: for a significant, separately identifiable E/M service provided by the same physician on the same day
• -24: to report a surgical procedure provided as a separately identifiable E/M service during a global post -surgical period
• -57: indicates that the decision to perform major surgery was arrived at during that visit
How a Medical Coding Company Can Help
From the foregoing details it is clear that family practice medical coding involves a lot of detailed study regarding the procedures and codes. Most physicians might find it challenging to master these details and guidelines amidst their busy schedule. Your practice can maximize revenue only by closely following payer requirements, assessing denied claims in a timely manner, and doing the necessary follow up. A reliable medical coding company with the right staff and infrastructure can be of great assistance. Most of these companies provide cost-effective services and you benefit from the services of some of the best coding professionals with in-depth knowledge regarding coding guidelines of different payers. They have the latest technology, utilize the latest reimbursement strategies, and follow advanced billing practices to ensure the best outcome for their clients.