Recent Questions from our Coding Corner Service

G-Code Billing for Cardiology:

Question: Do we have to use the G0275 for patients that have a non-selective renal angiography during a heart cath, that are not Medicare patients?

Answer: No. The Gcode or HCPCS codes are primarily for Medicare patients only. Medicare creates these codes to track utilization of certain services. In this case it is the abdominal aortogram, aka: non-selective renal angiography, during a cardiac catheterization.

New Patient vs. Established Patient:

Question: If our physician sees a patient in the hospital Emergency Room for a fracture and they then follow up in our office for fracture care, can be bill a new patient visit for the return office call since we never have seen the patient in the office before?

Answer: No. A New Patient codes (99201-99205) are for patients that have not had any professional services, by a physician of the same specialty, who belongs to the same group practice within the last 3 years. Only a follow up visit (99211-99215) can be billed or if your physician billed with the global fracture care on the first E/R encounter, then the patient is in the global period for the follow up care.

Consultation or Not?

Question: If a patient comes to the office at the request of another physician for an evaluation of abdominal pain, and our physician sends back a letter and report outlining his recommendations, but also initiates a diagnostic test on the same date, can we still bill for a consultation?

Answer: Yes. You can initiate diagnostic testing to help to render a diagnosis on a patient during a consultation. However, if the patient was only referred for a test or study, no consult can be billed. Your physician would have had to make the decision for the test after the initial exam was performed.

Stent and Angioplasties at the same setting:

Question: My physician performed a Percutaneous Transluminal Coronary Angioplasty (PTCA) in the Left Anterior Descending Artery (LAD). He also stented a diagonal side branch of the same vessel. Can I bill for both interventions?

Answer: No. According to the ACC CPT guide to coding and the AMA CPT Manual, coronary therapeutic interventions are coded by vessel, not by intervention. So any branch of a primary vessel is considered part of that vessel. The only code here to bill is 92980LD.

Gastroenterology Screening Colonoscopy:

Question: My physician performs screening colonoscopies at the request of a primary care physician. We have started to notice that we are not getting paid for any of our initial consultations or office visits when a screening colonoscopy is requested, why?

Answer: First of all, the patient was not sent to your office for an evaluation of a sign, symptom or indication. They were sent over for a screening, which usually means the patient has a family history of colon disease or is age appropriate for a screening. These are preventative services, and even though the physician needs to take a history on the patient before proceeding with the screening, there is no e/m component to be billed. Routine offices visits for preventative or no medical indication is not a covered benefit. Only the screening should be billed.