Top Ten Current Procedural Terminology Questions (Including Modifiers)

1. What Current Procedural Terminology (CPT®) code(s) can we report for a sports physical or other types of physicians (eg, school, camp)?
   
   After a certain age (usually 3 years), carriers only pay for one preventive medicine service a year. While sports physicals (also camp and school) are not the full preventive medicine service that is described in the CPT code, they are also not problem-focused services. In addition, CPT does not offer up a solution for this service, besides the unlisted preventive medicine service 99429.
   
   One alternative is to encourage parents to make their preventive medicine appointments later in the year if their child plans on playing sports or will require a school physical. If this is not an option, most offices have a policy to charge a flat fee for this service (not a form fee).
2. Which CPT code can we report for a postpartum depression screening administered to the mother?
   
   At this point, CPT does not have a specific code for this service. What is recommended as the most appropriate code is 99420. This can be reported under the baby’s name.
3. When our physician addresses an acute or a chronic illness during a routine preventive medicine service, can we report that? If so, how?
   
   If the acute or chronic illness requires a significant and separately identifiable evaluation and management (E/M) service, you may report an office-based E/M service (99201–99215) in addition to the preventive medicine service. Keep in mind the following important issues:
   1. Is this service medically necessary?
   2. Does my documentation support the reporting of both services?
      
      While there are no specific documentation guidelines on reporting 2 E/M services on the same date, it is important to keep the documentation of the preventive medicine services very clear and distinct from the documentation of the problem-focused service. Also, per CPT guidelines, you must append modifier 25 to the problem-focused E/M service (99201–99215).
4. What is the CPT and ICD-10-CM code for the new PREVNAR 13 vaccine?
   
   The CPT code you will report is 90670. The ICD-9-CM code that you will link to the product code and the appropriate vaccine administration code is Z23.
5. Can we report code 51701 when we perform a bladder catheterization on our younger patients to obtain a clean catch specimen, when they present with a fever of unknown origin? Can we also report an E/M service?
   
   Yes. CPT clarified in its Principles of CPT Coding book that collection of residual urine for clean catch urine specimen is an appropriate use of code 51701. Also note that if a significant and separately identifiable E/M service is performed in addition to the urine catheterization and you’ve documented it, you should report the E/M service (with modifier 25) and 51701.
   
   Note that Medicare does not allow for this.
6. How do we report the service for administering and checking a tuberculosis (TB) test? We administer it on one day and they return 2 to 3 days later for it to be checked by our nurse.
   
   Code 86580 should be reported for the administration and the serum on the date the TB test is administered. Note that code 86580 does not take into account reading the TB test at a later date. Therefore, you may report code 99211 when the patient returns for a reading only. Note that if there is a positive reaction, the patient would most likely be seen by the physician and therefore would warrant a higher level E/M service.
7. We administer objective screening tools for attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD), such as the Connors test. How can we code for that?
   
   The objective screening tools for ADD/ADHD can be reported with CPT code 96127.
8. How can we code for the extensive time our physicians take to counsel parents on vaccines if the parent refuses vaccination? Physicians are typically spending 10 to 15 minutes talking just about vaccines and vaccine safety.
   
   In a case in which your physicians are spending a great deal of time going over vaccines and the safety of vaccines, including answering extensive questions by parents, but the parents still refuse the vaccines, you can consider reporting the preventive medicine counseling codes (99401–99404) in addition to the preventive medicine services code. This should only be reported in those extreme cases in which the counseling becomes (in essence) its own service. Modifier 25 should be reported on the appropriate preventive medicine counseling code (99401–99404) and the physicians’ documentation must support the reporting of both services (http://www.aap.org/en-us/professional-resources/practice-support/Vaccine-Financing-Delivery/Pages/Immunization-Coding-Questions-and-Answers-from-the-AAP-Coding-Hotline.aspx and http://www.aap.org/en-us/professional-resources/practice-support/Vaccine-Financing-Delivery/Pages/Coding-for-the-Product--Administration-of-Influenza-Vaccine.aspx).
9. When our physician sees a patient in the office and then sends the patient to the hospital for an admission (not observation/critical/intensive), how should we code if the physician goes to the hospital that night for a face-toface service?
   
   Per CPT guidelines, an initial hospital care code (99221–99223) would include all related E/M services done at another site (including the emergency department or office). Therefore, you should have your physician consider all of the E/M work related to the patient for that day and include it under the appropriate initial hospital care code.
   
   Note that if the physician performed any procedures in the office, you may also report those in addition to the initial hospital care code.
10. How do we code for a visit to counsel a patient on international travel? The patient is healthy.
    
    Report preventive medicine counseling as your CPT code (99401–99404) based on the time spent.

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.