Coding help?

Latley we have had a rash of infected port removals (some a year out from placement). They need packing changes 3 times a week. So far I am only coding a 99212 is there something else I should be adding to this office visit?

Jeremy

It depends on if you are doing any debridement. There is a separate code for port removal and you should charge the CPT code for that. For wound care you would charge the appropriate code for the dressing change. 99212 would be appropriate for a dressing change with packing. If you do any debridement there is a separate CPT code 97597 which you can use if the wound is less than 20 cm. Here is a nice article on this:

http://www.memag.com/memag/Young+Doctors'+Resource+Center:+Practice+Management:+Coding/Coding-Consult/ArticleStandard/Article/detail/144775

Basically if you can charge for a procedure you should since it usually pays better than the E&M code.

The other issue is why are you doing the dressing change. This is usually a nursing task an the practice can charge a 99211. If you are debriding or have to make decisions about the wound then 99212 is appropriate. If the decision making is more than straightforward or the time component is longer than 15 minutes then a 99213 or even 214 may be appropriate.

David Carpenter, PA-C

David,Thank you or the advice. My current employer has the rn only do ivs, medication administration only, no dictations or procedures. Probably not the best use of skills but it is what they want.Jeremy

Just make sure that you address some other part of the medical care in your dictation. If nothing else you can comment on the wound appearance and healing characteristics. That should support at least a 99212.

I see that a lot. I was given a "competency" where one of the questions was how do you remove staples. I wrote "please remove staples and apply steri-strips" since the nurses here do this. The powers that be were less than amused. I actually like to remove staples and am pretty good at it. But if the best use of my time is to see another patient then that is what I need to do. If the nurses run into something like a buried staple then I am more than happy to help.

David Carpenter, PA-C