Coding Nuggets were provided by Jeannie C. Cagle, R.N., CPC, a senior consultant of The Coker Group with more than 20 years experience in clinical health. The Coker Group is an SMA approved partner.
February 2008
Question
We had an established patient show up in our office on Tuesday, last week. The patient was requesting to see the doctor, but did not have a scheduled appointment for that day. The patient explained to our receptionist that she had had a seizure that morning and wanted to see the doctor. Shortly afterward, the patient experienced a seizure and fell to the floor in an active seizure. The doctor was summoned from the exam room and responded to the patient, treated her, and remained with the patient until the patient's seizure ended and the patient was coherent enough to be moved to a seat. The patient was soon moved to an exam room and the doctor met with the patient again to discuss the morning seizure (the reason the patient had come to the office) and the in-office seizure.
The doctor coded the office visit a 99215 for the exam room visit with the patient. I believe the doctor should also be able to charge for emergency service provided to the patient in our reception area. I have looked through the CPT book, and the only thing I could find was 99058, "Office Emergency Care." Can we bill 99058 along with 99215?
Answer
You could use 99215 and 99058, but some insurance plans do not pay 99058. Under the circumstances that you have described, another appropriate billing would be the use of 99215 and then the addition of the prolonged service code (99354) for the additional time. This assumes the typical time for 99215 (40 minutes) and 99354 (additional 30 minutes). Remember that this all has to be total face-to-face time with the physician.
Question
We have a psychologist on staff currently seeing patients using medical procedure codes. She is being supervised by an M.D. and his signature goes on her reports along with hers. The M.D. is not in the room with her while she sees the patients but is present at the facility while the session takes place. The psychologist is sleep certified. Is this ok? Some people tell me that the M.D. needs to be present during the visit (same room); others tell me that his presence at the facility is good enough. The psychologist is a Ph.D., and the codes being used are the following: 99201 through 99205 for initial visits; 99242 through 99245 for consults; and 99211 through 99215 for follow- up.
Answer
The psychologists cannot bill E/M codes like the ones you listed under any circumstances, even with the physician in the same room. They can only document the same elements as a nurse: review of systems, past medical, family and social history, and vital signs. Other than that, it is NEVER okay for anyone other than a physician, nurse practitioner, or physician assistant to bill E/M codes.
