PRACTICE RESOURCES > Coding and Reimbursement > Coding Tips > Questions and Answers > Miscellaneous

Miscellaneous

Q.Is there a diagnosis code for penile fracture?
A.Use ICD-9-CM diagnosis code 959.13 Fracture of corpus cavernosum penis.

Q.How do I code for a patient's condition when I have not determined a diagnosis?
A.When you see a patient and cannot immediately determine a final diagnosis without lab results or other pending information, code the visit with ICD-9 coding, indicating the signs and/or symptoms that prompted ordering the test. Do not bill with an unconfirmed, possible diagnosis. Once the test results have been determined, then bill any subsequent visits with the confirmed ICD-9 diagnosis code. If the diagnostic test results are normal, use ICD-9 codes for the signs and/or symptoms that prompted the treating physician to order the study.

Q.When do I stop using the cancer ICD-9 codes and begin using the personal history V codes on a patient I treated for cancer?
A.You should use the cancer diagnosis as long as the patient is under active treatment. At the end of the treatment, if there are no signs and symptoms of the cancer, you may begin using the V codes. But there are exceptions. If the patient is taking cancer-suppressing drugs, continue to use the cancer ICD-9 codes, as the cancer is only under control and is not gone. The assignment of the diagnosis of cancer is under the judgment of the physician.

Q.Can I bill for a urinalysis and bladder scan during the postoperative period?
A.During the postoperative period, any type of laboratory/pathology or radiological procedure should be reimbursed by the insurance carrier. For Medicare, the reason that these types of services are allowed is because they have an "XXX" global which states that "the global concept does not apply to this code." Therefore they are not bundled into the global period of a surgery. There has been a problem with CPT® code 51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging, in the last year because it was moved to the Urinary System Section of CPT®. Some carriers are mistaking this for a surgical procedure when it is clearly a radiological procedure and carries the "XXX" global. It may be necessary to appeal these types of claims with your insurance carrier.

Q.Our urologist dictates the office notes and gives them to our transcriptionist. At the end of the notes, the transcriptionist types "Dictated but not read." The doctor does not review or sign the dictation. Will this pass an audit?
A.No. As any audit is based on documented notes in a patient's chart, the physician is responsible for the accuracy of his dictated material. The urologist must read and sign all documents in the patient's chart not only for medical and auditing reasons, but also for legal reasons.

Q.Our patient saw his urologist and internist on the same day - two entirely different physicians in two different practices. The claim for the urologist was denied. Can we appeal this decision?
A.Yes, this is definitely a case where an appeal should be pursued. Submit a cover letter with your appeal and outline the reason for the visit, medical necessity, and ask that this claim be reconsidered.

Q.What is the diagnosis code for Peyronie's disease?
A.ICD-9-CM diagnosis code, 607.85, was established for Peyronie's disease.

Q.Can I bill a 99211 "nurse" visit with the chemotherapy administration code?
A.No. The lowest level E/M service 99211 will not be reimbursed with the chemotherapy administration code.

Q.Will a -25 modifier still be required when an E&M Service (99212-99215 or 99202-99205) is provided on the same day with chemotherapy administration?
A.As of January 1, 2004, if an evaluation and management (E&M) service is provided by the physician or other Medicare approved healthcare provider (PA/NP) on the same day as the chemotherapy injection, then the E&M service must have the -25, Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service modifier appended to it. Make sure your documentation describes the medical necessity of the E&M service provided.

Q.Does the AUA have any documentation to assist with denied claims for certain urologic procedures?
A.The AUA has developed several clinical appeal letters to assist offices in appealing their denied claims. They are available here.

Q.My office is located within a Health Professional Shortage Area (HPSA) and/or a Physician Scarcity Area (PSA). Is a modifier necessary to get the quarterly bonus?
A.Depending on certain criteria, a modifier may be required to receive the HPSA/PSA quarterly bonus.

Effective January 1, 2006, Modifier AQ Physician providing service in a Health Professional Shortage Area (HPSA) has replaced modifiers QB rural HPSA and QU urban HPSA and Modifier AR Physician providing service in a Physician Scarcity Area (PSA) have been implemented.
Physician Scarcity Area (PSA)

Medicare will automatically pay a 5 percent bonus on PSA and a 10 percent bonus on HPSA services on a quarterly basis without the need for a modifier on the claim for services provided in ZIP code areas.

There is an overview of this bonus and how it is paid along with a zip code list at www.cms.gov/HPSAPSAPhysicianBonuses/01_overview.asp.

Some key points to remember regarding the HPSA/PSA bonuses are the following: 

Q.How do I code for Physician Quality Reporting System (PQRS)?
A.The AUA has put together a valuable toolkit to help your office with reporting measures.

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