Re: coding for tick removal

[Guest guest]

99214 and call it quits?

How do I code for procedure of tick removal using Lidocaine and Epi to make the bugger release?  I can't use a CPT for iscision and removal.  Not sure how to price out the Lido and Epi as well. Then while I had her here I addressed her hypertension and high cholesterol and obesity and COPD.  So which E/M gets the modifier?  Thanks.

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.Remember  that e-mail may not be entirely secure/     MD

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[Guest guest]

hahahaha

Don't you know I'm greedy and want the penny check Joanne got?

How do I code for procedure of tick removal using Lidocaine and Epi to make the bugger release? I can't use a CPT for iscision and removal. Not sure how to price out the Lido and Epi as well.. Then while I had her here I addressed her hypertension and high cholesterol and obesity and COPD. So which E/M gets the modifier? Thanks..

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

[Guest guest]

Dear Myria, I work not that far from you, in an urgent care in Latham, so I see loads of ticks. Some weeks, I remove 5 or more. I have never spent more than 10 seconds removing even the most deeply embedded tick. This is because the urgent care owns a tiny green plastic tool which can be seen on the website otom.com. This tool exploits the fact that tick mouthparts, while having upward-directed spines that prevent the tick from being pulled straight out, cannot withstand a spinning motion. Thus, the tick comes right out before I even suspect it is loose; I never leave any of the tick behind. I have never had it fail. The only problem, if you can even call it one, is that the device may pull on hair if the tick is in the scalp; this may scare a small child who anticipates a painful procedure. In reality, there is no pain involved whatsoever. 

It is really important to use the tool as directed; that is, once the tick is lodged in the groove, spin the tick till it's out, don't pull it. The nurse who runs the clinic says the devices are hard to find and cost $9 for a set (one big one and one little one). They used to be readily available at feed stores and pet stores; I'm not sure if they still are.

Worth a try! Not really reimbursible, though...

Felix

coding for tick removal

How do I code for procedure of tick removal using Lidocaine and Epi to make the bugger release?  I can't use a CPT for iscision and removal.  Not sure how to price out the Lido and Epi as well. Then while I had her here I addressed her hypertension and high cholesterol and obesity and COPD.  So which E/M gets the modifier?  Thanks.

Shopping for Mom? Save yourself a little time and money on AOL Shopping.

[Guest guest]

Thanks for the heads up. I'll look into it. I had heard twisting leaves mouth parts, so was hesitant about any of the "gadgets".

Subject: Re: coding for tick removalTo: Date: Friday, May 8, 2009, 12:03 PM

Dear Myria, I work not that far from you, in an urgent care in Latham, so I see loads of ticks. Some weeks, I remove 5 or more. I have never spent more than 10 seconds removing even the most deeply embedded tick. This is because the urgent care owns a tiny green plastic tool which can be seen on the website otom.com. This tool exploits the fact that tick mouthparts, while having upward-directed spines that prevent the tick from being pulled straight out, cannot withstand a spinning motion. Thus, the tick comes right out before I even suspect it is loose; I never leave any of the tick behind. I have never had it fail. The only problem, if you can even call it one, is that the device may pull on hair if the tick is in the scalp; this may scare a small child who anticipates a painful procedure. In reality, there is no pain involved whatsoever.

It is really important to use the tool as directed; that is, once the tick is lodged in the groove, spin the tick till it's out, don't pull it. The nurse who runs the clinic says the devices are hard to find and cost $9 for a set (one big one and one little one). They used to be readily available at feed stores and pet stores; I'm not sure if they still are.

Worth a try! Not really reimbursible, though...

Felix

[Practiceimprovemen t1] coding for tick removal

How do I code for procedure of tick removal using Lidocaine and Epi to make the bugger release? I can't use a CPT for iscision and removal. Not sure how to price out the Lido and Epi as well. Then while I had her here I addressed her hypertension and high cholesterol and obesity and COPD. So which E/M gets the modifier? Thanks.

Shopping for Mom? Save yourself a little time and money on AOL Shopping.

[Guest guest]

>Just go to www.ticktwister.com to order them. I can't wait to try mine, but

haven't seen any ticks yet this spring!---Sharlene---

> Dear Myria, I work not that far from you, in an urgent care in Latham, so I

see loads of ticks. Some weeks, I remove 5 or more. I have never spent more than

10 seconds removing even the most deeply embedded tick. This is because the

urgent care owns a tiny green plastic tool which can be seen on the website

otom.com. This tool exploits the fact that tick mouthparts, while having

upward-directed spines that prevent the tick from being pulled straight out,

cannot withstand a spinning motion. Thus, the tick comes right out before I even

suspect it is loose; I never leave any of the tick behind. I have never had it

fail. The only problem, if you can even call it one, is that the device may pull

on hair if the tick is in the scalp; this may scare a small child who

anticipates a painful procedure. In reality, there is no pain involved

whatsoever. 

>

>

>

> It is really important to use the tool as directed; that is, once the tick is

lodged in the groove, spin the tick till it's out, don't pull it. The nurse who

runs the clinic says the devices are hard to find and cost $9 for a set (one big

one and one little one). They used to be readily available at feed stores and

pet stores; I'm not sure if they still are.

>

>

>

>

> Worth a try! Not really reimbursible, though...

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> Felix

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> How do I code for procedure of tick removal using Lidocaine and Epi to make

the bugger release?  I can't use a CPT for iscision and removal.  Not sure how

to price out the Lido and Epi as well. Then while I had her here I addressed her

hypertension and high cholesterol and obesity and COPD.  So which E/M gets the

modifier?  Thanks.

>

[Guest guest]

Thanks for the reminder, .

This device was mentioned last November 2008.

Seems like a nifty device. Haven't used yet in the office.

I guess a TickTwister is better than a Purple Nurple.

http://www.urbandictionary.com/define.php?term=purple+nurple

Here is a google of the tool...

    http://tinyurl.com/pdoeaa

And the previous posting below.

Locke, MD

Locke wrote:

Interesting

widget mentioned on another list.

 

I went

ahead and ordered a kit -- $7.90 w/ shipping.

 

Not too

expensive and looks pretty easy to use.

 

Video of use

at...

 

 

http://www.ticktwister.com/

Again,

no connection -- just thought it was a cool product.

 

rftulie@... wrote:

Dear Myria, I work not that far from you, in an urgent care in

Latham, so I see loads of ticks. Some weeks, I remove 5 or more. I have

never spent more than 10 seconds removing even the most deeply embedded

tick. This is because the urgent care owns a tiny green plastic tool

which can be seen on the website otom.com. This tool exploits the fact

that tick mouthparts, while having upward-directed spines that prevent

the tick from being pulled straight out, cannot withstand a spinning

motion. Thus, the tick comes right out before I even suspect it is

loose; I never leave any of the tick behind. I have never had it fail.

The only problem, if you can even call it one, is that the device may

pull on hair if the tick is in the scalp; this may scare a small child

who anticipates a painful procedure. In reality, there is no pain

involved whatsoever. 

It is really important to use the tool as directed; that is,

once the tick is lodged in the groove, spin the tick till it's out,

don't pull it. The nurse who runs the clinic says the devices are hard

to find and cost $9 for a set (one big one and one little one). They

used to be readily available at feed stores and pet stores; I'm not

sure if they still are.

Worth a try! Not really reimbursible, though...

Felix

coding for tick removal

How do I code for procedure of tick removal using

Lidocaine and Epi to make the bugger release?  I can't use a CPT for

iscision and removal.  Not sure how to price out the Lido and Epi as

well. Then while I had her here I addressed her hypertension and high

cholesterol and obesity and COPD.  So which E/M gets the modifier? 

Thanks.

Shopping for Mom? Save

yourself a little time and money on AOL Shopping.

[Guest guest]

Myria, your original question was how to code for a tick removal.

It looks like you bill for E & M and not procedure if you just pluck

it out.

But if you did the injection, it sounds like you should be able to bill

for that, but I'm not sure how.

Here are some thoughts...

http://www.aafp.org/fpm/20060300/coding.html

ICD-9 code for tick removal

Q What is the proper ICD-9 code for removing

a tick?

A There is no specific ICD-9 code for tick

infestation on the skin, although there are such codes for chiggers,

lice and leeches. Because a tick is technically a mite, the proper

ICD-9 code would be 133.9, "Acariasis, unspecified."

http://www.aafp.org/fpm/20050600/coding.html

CPT code for tick removal

Q What

is the proper procedure code for removing a tick, intact, from a

patient's scalp?

A The removal of an outside element

(e.g., tick, ring, splinter) that does not require incision is

considered part of the management of the problem; therefore, you should

simply use an appropriate evaluation and management (E/M) code for the

encounter.

https://www.hcpro.com/HIM-59235-859/Code-tick-removal-depending-on-leveling-guidelines.html

QUESTION: If a patient presents to the ED with a tick bite

(with whole or part of the tick still embedded) and the physician uses

tweezers or his hands to remove the tick, how should we code the

procedure? Should we use a CPT code for a removal of foreign body, or

should we include it in our E/M leveling system?

ANSWER: Whether the procedure is separately billable

depends on the E/M facility guidelines you employ for your ED. If you

use a point system, your E/M level descriptions may include the

procedure as an intervention. If it is included, do not separately bill

the removal.

If the procedure is not included, then it may be separately

billable. Consider the tick as a foreign body and report it with the

appropriate CPT code (for example, if the physician performs an

incision to remove the tick, use 10120, Incision and removal of foreign

body, subcutaneous tissues; simple).

The documentation should reflect the resources used for evaluation

and for the procedure. Be sure to append modifier -25 to the E/M code.

Note that for removal by hand or tweezers, as cited in your example,

report the service using the appropriate E/M code.

Locke, MD

Myria wrote:

How do I code for procedure of tick removal using

Lidocaine and Epi to make the bugger release? I can't use a CPT for

iscision and removal. Not sure how to price out the Lido and Epi as

well. Then while I had her here I addressed her hypertension and high

cholesterol and obesity and COPD. So which E/M gets the modifier?

Thanks.

[Guest guest]

I have always felt that even if you KNOW it won't be paid, code it anyway. The more denied and bundled codes we have, the more ammunition we have against the insurance monsters. Anyway, I would code 99214 with tick removal as the modified add on. The lido and other stuff is always considered part of the removal.

To: Sent: Friday, May 8, 2009 12:03:31 PMSubject: Re: coding for tick removal

Dear Myria, I work not that far from you, in an urgent care in Latham, so I see loads of ticks. Some weeks, I remove 5 or more. I have never spent more than 10 seconds removing even the most deeply embedded tick. This is because the urgent care owns a tiny green plastic tool which can be seen on the website otom.com. This tool exploits the fact that tick mouthparts, while having upward-directed spines that prevent the tick from being pulled straight out, cannot withstand a spinning motion. Thus, the tick comes right out before I even suspect it is loose; I never leave any of the tick behind. I have never had it fail. The only problem, if you can even call it one, is that the device may pull on hair if the tick is in the scalp; this may scare a small child who anticipates a painful procedure. In reality, there is no pain involved whatsoever.

It is really important to use the tool as directed; that is, once the tick is lodged in the groove, spin the tick till it's out, don't pull it. The nurse who runs the clinic says the devices are hard to find and cost $9 for a set (one big one and one little one). They used to be readily available at feed stores and pet stores; I'm not sure if they still are.

Worth a try! Not really reimbursible, though...

Felix

[Practiceimprovemen t1] coding for tick removal

How do I code for procedure of tick removal using Lidocaine and Epi to make the bugger release? I can't use a CPT for iscision and removal. Not sure how to price out the Lido and Epi as well. Then while I had her here I addressed her hypertension and high cholesterol and obesity and COPD. So which E/M gets the modifier? Thanks.

Shopping for Mom? Save yourself a little time and money on AOL Shopping.

[Guest guest]

I always use “foreign body

removal-skin”. Can not recall the CPT code. If tick not intact but

deeply embedded, have even resorted to using punch biopsy technique.

Not sure if it is covered; certainly need the

25 modifier if doing E & M visit at same time.

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

NOTE NEW ADDRESS AND PHONE NUMBER:

269 Peninsula Farm Road

Suite F

Arnold, MD 21012

410 518-9808

From: [mailto: ] On Behalf Of Locke

Sent: Saturday, May 09, 2009 4:51

AM

To:

Subject: Re:

coding for tick removal

Myria, your

original question was how to code for a tick removal.

It looks like you bill for E & M and not procedure if you just pluck it out.

But if you did the injection, it sounds like you should be able to bill for

that, but I'm not sure how.

Here are some thoughts...

http://www.aafp.org/fpm/20060300/coding.html

ICD-9 code for tick removal

Q What is the proper ICD-9 code for removing a tick?

A There is no specific ICD-9 code for tick infestation

on the skin, although there are such codes for chiggers, lice and leeches.

Because a tick is technically a mite, the proper ICD-9 code would be 133.9,

" Acariasis, unspecified. "

http://www.aafp.org/fpm/20050600/coding.html

CPT code for tick removal

Q

What is the proper procedure code for removing a tick, intact, from a patient's

scalp?

A

The removal of an outside element (e.g., tick, ring, splinter) that does not

require incision is considered part of the management of the problem;

therefore, you should simply use an appropriate evaluation and management (E/M)

code for the encounter.

https://www.hcpro.com/HIM-59235-859/Code-tick-removal-depending-on-leveling-guidelines.html

QUESTION: If a patient presents to the ED

with a tick bite (with whole or part of the tick still embedded) and the

physician uses tweezers or his hands to remove the tick, how should we code the

procedure? Should we use a CPT code for a removal of foreign body, or should we

include it in our E/M leveling system?

ANSWER: Whether the procedure is separately

billable depends on the E/M facility guidelines you employ for your ED. If you

use a point system, your E/M level descriptions may include the procedure as an

intervention. If it is included, do not separately bill the removal.

If the

procedure is not included, then it may be separately billable. Consider the

tick as a foreign body and report it with the appropriate CPT code (for

example, if the physician performs an incision to remove the tick, use 10120,

Incision and removal of foreign body, subcutaneous tissues; simple).

The

documentation should reflect the resources used for evaluation and for the

procedure. Be sure to append modifier -25 to the E/M code. Note that for

removal by hand or tweezers, as cited in your example, report the service using

the appropriate E/M code.

Locke, MD

Myria wrote:

How do I code for procedure of tick removal using

Lidocaine and Epi to make the bugger release? I can't use a CPT for

iscision and removal. Not sure how to price out the Lido

and Epi as well. Then while I had her here I addressed her hypertension and

high cholesterol and obesity and COPD. So which E/M gets the modifier?

Thanks.