During the Prevention visit, I have a patient with a new diagnosis of diabetes. to make it a diagnostic appointment and educate the patient on diabetes. …
PHA Coding Frequently Ask Questions
1 A patient comes in for a Periodic Health Assessment and they have an
elevated blood pressure How do I code this visit?
Answer: Your primary ICD-9 code would be V705_2 since the patients
initial reason for the appointment is the PHA screening However, if you
find an additional screening symptom during the exam such as elevated BP,
you would add the ICD-9 code 7962 Code the EM with the appropriate age
specific Preventive Medicine Exam code 9938x or 9939x
2 During the Prevention visit, I have a patient with a new diagnosis of
diabetes How would I code this?
Answer: If during a Prevention visit you perform an exam and reveal a new
diagnosis that you will work up and will document on fully you would code
diabetes, 250xx as an additional diagnosis A second EM code with
modifier 25, for example 99212, would be used to note a significant,
separately identifiable EM service by the same provider on the same day
3 During this visit, I decide to make it a diagnostic appointment and
educate the patient on diabetes How would I code this?
Answer: During this visit if you decide to change the prevention counseling
or exam appointment to a
diagnostic appointment but you perform a great
deal of education which is greater than 50 of the encounter, then time
would be the dominating factor for the visit You must document the total
time of the encounter, the time spent counseling and the content of the
counseling in your note Use an Office Visit EM code for this service
9920x or 9921x
4 I have a patient come in for their prevention visit and exam At the
end of the exam the patient requests that I refill their birth control
pills How would this be coded?
Answer: If during the Prevention visit you perform an exam and the patient
also requests a refill of medication on a current problem, code V2541,
refill of birth control pills, as an additional diagnosis You may NOT add
any additional EM or modifier because it is an established problem
5 The PHA is NOT performed by a credentialed provider How would this be
coded?
Answer: In the event a PHA is not a face-to-face encounter, eg, review of
form; this is an administrative function and not a code able event If the
PHA results in a face-to-face encounter with a non-credentialed provider
you may use one of two EM codes Code 99211 if there are no procedures
performed
or 99499 as the EM code along with any procedures performed
AS SOON AS THE NEW HIPAA TAXONOMY CODE FOR IDCS BECOMES AVAILABLE, IDCS
WILL BE ABLE TO USE THE FULL RANGE OF EM CODES
However 99499 is only a space holder to get you to the next screen it does
NOT hold any RVU value I would recommend that you use 99211 and be sure
to add appropriate CPT codes to help increase RVU value whenever possible
especially if you are not having PHA performed by a credentialed provider
RVUs are a combination of the EM codes with the CPT codes Your ICD-9
codes must support the CPT codes selected Be sure to list all procedures
that occurred in your spaces, eye exam, education, EKG, audiometry, pap
smear, immunizations etc find out what the CPT codes are and make sure
your provider and ancillary staff have them available to use Do not
include CPT codes for procedures that do not occur in your spaces For
example, if the immunization is not give in your clinic you can not take
credit for it
6 How do I code a Physical exam along with the PHA screen? Note: You
might want to make this 1 as the lead in???
Answer:
ICD-9 Code: V705_2 Health examination of defined subpopulations ie Armed
forces as
the primary, add additional ICD-9 codes when appropriate
EM Code: Use Prevention Visit codes by age range such as:
New vist:
99385 RVU 153 18-39 yrs
99386 RVU188 40-64 yrs
Established visit:
99395 RVU 136 18-39 yrs
99396 RVU 153 40-64 yrs
7 How do I code vaccinations given in our Immunization Clinic?
Answer: 90471 is the administration of one vaccine, and the vaccine itself
is also added for example Td is 90718 or Typhoid is 90693 If you give 2
or more vaccines you add on 90472 for each additional vaccine administer
For vaccines given by intranasal route you would use the code 90473 as the
administration code Every vaccine must be accompanied by an
administration code and the appropriate diagnosis code Immunizations if
done in the same clinic if done under another MEPRS then credit goes to
that clinic
8 As part of the PHA my clinic performs an EKG, Audiometry, Snelling Eye
Exam, and provides patient education materials How do we code this?
NOTE: My clinicwhat does this mean? Who is performing these services?
If a privileged provider is then the EKG could be professional component
only, technical only or global procedure
Answer: The CPT codes would be:
93005 EKG
technical components only if technical part done in clinic If
performed and read in another MEPRS then total credit goes to that clinic
You can not unbundle the code
92552 Audiometry
99173 Snelling Eye Exam
9 What if we add prevention counseling to the visit?
Answer: ICD-9 code: V705_2 Health examination of defined subpopulations
ie Armed forces as the primary, add additional ICD-9 codes when
appropriate
EM Codes: 99401 Prevention Counseling 15 mins 048 RVUS
99402 Prevention Counseling 30 mins 098 RVUS
99403 Prevention Counseling 45 mins 146 RVUS
10 What are some of the signs/symptoms ICD-9 codes that we may use?
Answer: Signs and Symptoms ICD-9 codes 2006:
462 Sore throat
7962 Elevated blood pressure reading without diagnosis of hypertension
7963 Nonspecific low blood pressure reading
7964 Other abnormal clinical findings
78079 Other Malaise and fatigue
7837 Failure to thrive adult
7840 Headache
785 Symptoms involving cardiovascular system:
7851 Palpitations
7852 Heart Murmurs NOS
786Symptoms involving respiratory system:
78603 Apnea
78605 Shortness of Breath
78607 Wheezing
7862 Cough
793x
Nonspecific abnormal findings on radiological and other examination
of body structure
Includes: abnormal findings of - thermography, ultrasound examination, x-
ray examination
Excludes: abnormal results of function studies and radioisotope scans
7940-7949
11 What codes do I use if there are abnormal lab results when ordering a
Scan?
Answer: 794 series codes are for SCANS When you are referring to Abnormal
Blood lab studies use the 790 code series
7944 Abnormal renal kidney function test
7945 Abnormal Thyroid results
7946 Other endocrine function study
7948 Abnormal Liver scan
7949 Abnormal Bladder, Pancreas, Placenta, Spleen study
12 How do we code when a patient has an positive TB skin test but does
not have the active tuberculosis?
Answer: 7955 Nonspecific reactions to tuberculin skin test without active
tuberculosis
Source: BUMED, CDR Dorn @ 202-762-3585
