CPT Code: 99307 (Subsequent Nursing Facility care) ICD-10-CM: G30.8 ( Subsequent follow-up care is provided for the patient who was transferred to a skilled nursing facility from an acute care hospital after partial recovery from a stroke. The patient has developed periods of extreme dizziness and mental confusion.
Many codes in Chapter 19 of ICD-10-CM (Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)) require a 7th character to identify the episode of care: initial, subsequent, or sequela.
CPT Code: 99342 (New Patient Home Visit) ICD-10-CM: R60.0 ( Subsequent follow-up care is provided for the 82-year-old male nursing facility patient with Alzheimer's disease.
Z47.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z47.89 became effective on October 1, 2021. This is the American ICD-10-CM version of Z47.89 - other international versions of ICD-10 Z47.89 may differ. Z codes represent reasons for encounters.
Follow-up visits, like initial visits, should be coded using the appropriate evaluation and management (E/M) code (i.e., 99211–99215). Given the limited interaction with the patient and limited work involved, the level of service is likely to be low (e.g., 99211 or 99212).
When a diagnosis is not established at the first visit and follow-up visits are required before determining a primary diagnosis, what should the coder do? Code the signs and symptoms. (Instead of inconclusive diagnoses, the specific signs and symptoms are coded and reported.)
The emergency department is defined as an organized, hospital-based facility for the provision of unscheduled or episodic services to patients who present for immediate medical attention. It must be available 24 hours per day.
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.
ICD-10-CM defines subsequent encounters as “encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase.
Example 2: A subsequent encounter (character “D”) describes an episode of care during which the patient receives routine care for her or his condition during the healing or recovery phase.
Emergency department visit 99284 is used for the evaluation and management of a patient, which requires the following 3 components: A detailed history; A detailed examination ;and. Medical decision making of moderate complexity.
CPT® code 99214: Established patient office or other outpatient visit, 30-39 minutes.
Inpatient hospital visits99232 : Inpatient hospital visits: Initial and subsequent Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.
Established patient office or other outpatient visitCPT® code 99212: Established patient office or other outpatient visit, 10-19 minutes.
CPT 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused history; a problem focused examination; straightforward medical decision making.
CPT 99214 Description: An outpatient visit or office visit of an established patient. The visit involves management and evaluation. Straightforward level of medical decision making is needed and the visit takes 30 – 39 minutes. CPT 99215 Description: An outpatient visit or office visit of an established patient.
Medicare requires that modifier –25 always be appended to the emergency department (ED)E/M code (99281-99285) when provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s).
E&M codes 99284 and 99285 are not reimbursable together or more than once to the same provider, for the same recipient and date of service. Instead, providers should use code 99283 to bill for second and subsequent recipient visits on the same date of service.
Emergency Department (ED) Evaluation and Management (E/M) codes are typically reported per day and do not differentiate between new or established patients. There are 5 levels of emergency department services represented by CPT codes 99281 – 99285.
The ED physician should bill an E/M code (ED visits, 99281-99285), while the orthopedist can bill either a visit from that same code range or an office or outpatient service code (99201-99215), depending on whether the orthopedist considers the patient new or established.
99251. A pulmonologist is asked, by the patient's primary physician, to see a 14-month-old boy who was admitted to the hospital with respiratory distress, cough, and fever. A comprehensive history is taken from the infant's parents.
A 16-year-old female is being admitted by her family practice physician with a 2-week history of fatigue and fever. It has been progressively getting worse. She is suffering from dehydration. The physician performs a comprehensive history to look for explanations for her fatigue, including recent activity level and recent sleep habits. A detailed examination is performed and she is diagnosed with mononucleosis and admitted for treatment.
ICD-10-CM says the seventh character S is “for use for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequelae of the burn.” In other words, sequela are the late effects of an injury.#N#Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all. As time passes, the pain becomes intolerable and the patient seeks a pain remedy.#N#A late effect can occur only after the acute phase of the injury or illness has passed; therefore, you cannot report a code for the acute illness and a code for the late effect at the same encounter, for the same patient. The only exception occurs if both conditions exist (for example, the patient has a current cerebrovascular condition and deficits from an old cerebrovascular condition).#N#When reporting sequela (e), you usually will need to report two codes. The first describes the condition or nature of the sequela (e) and second the second describes the sequela (e) or “late effect.” For example, you may report M81.8 Other osteoporosis without current pathological fracture with E64.8 Sequelae of other nutritional deficiencies (calcium deficiency).#N#If a late effect code describes all of the relevant details, you should report that one code, only (e.g., I69.191 Dysphagia following nontraumatic intracerebral hemorrhage ).#N#For example: A patient suffers a low back injury that heals on its own. The patient isn’t seeking intervention for the initial injury, but for the pain that persists long after. The chronic pain is sequela of the injury. Such a visit may be reported as G89.21 Chronic pain due to trauma and S39.002S Unspecified injury of muscle, fascia and tendon of lower back, sequela.
ICD-10-CM defines subsequent encounters as “encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following injury treatment.”#N#A seventh character “D” is appropriate during the recovery phase, no matter how many times he has seen the provider for this problem, previously.#N#Note that ICD-10-CM guidelines do not definitively establish when “active treatment” becomes “routine care.” Active treatment occurs when the provider sees the patient and develops a plan of care. When the patient is following the plan, that is subsequent. If the provider needs to adjust the plan of care—for example, if the patient has a setback or must returns to the OR—the care becomes active, again.
In other words, sequela are the late effects of an injury. Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all.
A late effect can occur only after the acute phase of the injury or illness has passed; therefore, you cannot report a code for the acute illness and a code for the late effect at the same encounter, for the same patient.
Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state. Type 2 Excludes.
In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere.". Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code.
When the reason for an encounter is aftercare following a procedure or injury, the 2012 ICD-10-CM Official Guidelines and Reporting should be consulted to ensure that the correct code is assigned. Codes for reporting most types of aftercare are found in Chapter 21. However, aftercare related to injuries is reported with codes from Chapter 19, using seventh-character extensions to identify the service as aftercare.
The codes for factors influencing health and contact with health services represent reasons for encounters. In ICD-10-CM, these codes are located in Chapter 21 and have the initial alpha character of “Z,” so codes in this chapter eventually may be referred to as “Z-codes” (just as the same supplementary codes in ICD-9-CM were referred to as “V-codes”). While code descriptions in Chapter 21, such as aftercare, may appear to denote descriptions of services or procedures, they are not procedure codes. These codes represent the reason for the encounter, service or visit, and the procedure must be reported with the appropriate procedure code.
Aftercare visit codes cover situations occurring when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or care for the long-term consequences of the disease.
Codes for encounters for antineoplastic radiation, chemotherapy and immunotherapy (Z51.0, Z51.1-) are assigned if the sole reason for the encounter is antineoplastic therapy – even if the patient still has the neoplastic disease.