With cuts to fee schedules across the board, providers are looking for ways to keep their revenue up. I put this list together for one of my new customers and I thought it might be helpful for you guys as well. Please remember, each of these codes needs to be billed with the proper modifiers and all that jazz. Some of my previous posts do have the general rules on how to use the modifier 25 and 59 to make sure you can get paid separately for these additional codes. Ok, here we go.
1. Transitional Care – This set of codes is designed to help decrease the amount of hospital readmissions by encouraging patients and physicians to follow up at the office following a hospital discharge. The insurances pay up to $100.00 per visit more for these services then for regular office visits. You would use CPT codes 99495 and 99496.
2. Smoking cessation counseling – Not every insurance pays for this, but since you are probably doing this anyway, you might as well get paid for it at least some of the time. This code pays between $12 and $17 depending on the insurance and patient’s plan.
- Use HCPCS code G0436
- Use ICD9 305.1
3. Obesity Counseling – Again, not every insurance pays for this, but most of them will now. They reimburse up to $30.00 in addition to the office visit for this code. A patient’s BMI must be above 30.0 for the obesity counseling to be eligible for payment, and you are probably also doing this already as well.
- Use HCPCS code G0447
- Use ICD9 codes V85.30 through V85.45
4. Phsyicals – I cannot tell you how many of our doctors have coded their physicals as office visits and lost money for years. Using the proper preventative codes will pay more per visit than regular office visit codes.
- Use CPT codes 99381 – 99387 for new patients
- Use CPT codes 99391 – 99397 for established patients
- Use DX V20.2 for children under 18 and V70.0 for patients over 18
5. Office visits with preventative services – Often people who come in for a physical also then discuss things like adjusting their meds or bringing up new medical issues. Then the doctor will spend a portion of their time addressing things that are not covered under the “risk factor reduction intervention and counseling/anticipatory guidance” that a preventative service covers. In those cases you can code BOTH a preventative code AND an office visit on the same day. We also have a doctor who significantly increased her per visit reimbursement and the overall health of her patients by simply asking her patients if they would like to take care of their upcoming preventative services while they are already in the office for an unrelated medical issue. Physicals, pap smears, and prostate exams happen on a much more regular basis for her patients than in most offices and she increased her monthly revenue by 10-15%. For any questions on how to do this, please see my modifier 25 and 59 post.
6. Injections – To be honest, you will not make any money on the substances themselves. The insurances barely reimburse your costs. Many doctors choose to have things like toradol, rocephin, and kenalog on hand to teat acute pain, infections, and allergic reactions without having to send the patient to an urgent care. If you use the proper modifiers and manage the medical necessity of each line item properly, you can get paid about $30.00 per injection on the administration of the substance. Use the code 96372 and make sure you use the same DX on the J-code as you do on the 96372.
7. Tetanus shots – Many adults only received their tetanus shots in childhood. We have a provider who routinely tells patients who have not received a tetanus shot in 10 years that she would recommend they have a tetanus shot while in the office. Medicare will NOT pay for this unless the patient has been injured (please see my Medicare and Immunizations post). Every other insurance will pay. Our other doctor does it for Medicare patients anyway, but it’s your office is up to you. Insert smiley face here.
- Use the CPT code 90714 for TD, 90703 for tetanus toxoid, and 90715 for DTaP
- Use ICD9 code V06.5 for TD, V03.7 for tetanus toxoid, and V06.1 for DTaP
PLEASE, PLEASE make sure that you indicate EVERY service you do, even if you think it isn’t reimbursable. Your biller might know some tips and tricks that you aren’t aware of.
As always, if something I suggest isn’t getting paid, email me at firstname.lastname@example.org, or call me at (909) 374-5439. Of course I hope that you will find me so knowledgeable and easy to work with that you will immediately sign up for one of my webinars or call me in for an analysis of your practice. But if that isn’t on your schedule or in your budget, I am still here to help, especially for quick questions like that.