Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 Nita: May I suggest you place PPD on one day and have her return 48 hours later for reading and the skin procedure? I would actually have her pay the co-pay both times…but that is just me. Some insurance requires the co-pay every time a patient is seen; it is part of the patient’s contract…(and yours if you are in network) On the other hand, I do not ever charge for the reading of a PPD as long as it is negative. I think if you do both on one day there is that always present risk that the insurance will cover the “lesser” of the two fees, especially if they do not honor a 25 modifier. Depending on your willingness to take that risk, you will want to use the modifier for “separate and identifiable service” on same day. Finally, if PPD is being placed for employment purposes only, some insurers will also deny coverage for that purpose. (non medically necessary) 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 Dr Levin Sent: Tuesday, January 20, 2009 10:17 PM To: Subject: Re: (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 > > Have her come in for PPD placement, but don't charge copay for that. > > Come another time for the skin biopsy. > > I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. For example, BCBSIL will pay the entire amt for a depo shot, so the patient does not have to pay a copay. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 Thanks for your input. So should I call the insurance company to see if they will cover the cpt for ppd and if the pt owes a copay? Doing the two procedures on separate days makes sense. Just a hassle for the patient though. Are we expected to routinely prior authorize derm lesion excision/biopsy with the insurance company prior to services? Nita To: Sent: Tuesday, January 20, 2009 10:25:56 PMSubject: RE: (unknown) Nita: May I suggest you place PPD on one day and have her return 48 hours later for reading and the skin procedure? I would actually have her pay the co-pay both times…but that is just me. Some insurance requires the co-pay every time a patient is seen; it is part of the patient’s contract…(and yours if you are in network) On the other hand, I do not ever charge for the reading of a PPD as long as it is negative. I think if you do both on one day there is that always present risk that the insurance will cover the “lesser” of the two fees, especially if they do not honor a 25 modifier. Depending on your willingness to take that risk, you will want to use the modifier for “separate and identifiable service” on same day. Finally, if PPD is being placed for employment purposes only, some insurers will also deny coverage for that purpose. (non medically necessary) Ramona Ramona G. Seidel, MD www.baycrossingfami lymedicine. com Your Bridge to Health NOTE NEW ADDRESS AND PHONE NUMBER: 269 Peninsula Farm RoadSuite F Arnold, MD 21012 410 518-9808 From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of Dr LevinSent: Tuesday, January 20, 2009 10:17 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA [Practiceimprovemen t1] (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks.. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 I have yet another answer. Usually, the problem with getting paid for two CPT codes on one day is getting paid for and E & M code plus another CPT so doing a HTN visit with the skin bx. Then you use the -25 modifier which I don’t think United HC pays yet, as it takes them 2 years to make changes in their computer system. SO I would go ahead a place it using the code for the PPD and doing the skin bx. They usually do not pay an E & M code for placing a PPD, just the PPD code anyway. When she comes back, you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative. You collect a co-pay for that. I do not know if “procedures” other than an E & M code require co-pays (like skin bx day) but I would collect and at worse, you credit or give it back. I would not collect 2 co-pays on skin bx/PPD day. That is usually only done with a E & M code on same day as a Preventive Health Maintenance exam. You will probably get as many answers as people who answer. The rules change state to state too. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of RGMS Sent: Tuesday, January 20, 2009 10:26 PM To: Subject: RE: (unknown) Nita: May I suggest you place PPD on one day and have her return 48 hours later for reading and the skin procedure? I would actually have her pay the co-pay both times…but that is just me. Some insurance requires the co-pay every time a patient is seen; it is part of the patient’s contract…(and yours if you are in network) On the other hand, I do not ever charge for the reading of a PPD as long as it is negative. I think if you do both on one day there is that always present risk that the insurance will cover the “lesser” of the two fees, especially if they do not honor a 25 modifier. Depending on your willingness to take that risk, you will want to use the modifier for “separate and identifiable service” on same day. Finally, if PPD is being placed for employment purposes only, some insurers will also deny coverage for that purpose. (non medically necessary) 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 Dr Levin Sent: Tuesday, January 20, 2009 10:17 PM To: Subject: Re: (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA ----- Original Message ----- From: Nivedita Bijoor To: Sent: Tuesday, January 20, 2009 8:49 PM Subject: (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 nivedita there is never a charge for reading the ppd .the code 86580 is for placing and reading it There are never two separete cahrgesPPD stuff is really quick and cheap She does need to come in twice but If it was me I would do both the same day charge one c opay and then she bops by for a 2min reading that you write down for her IF teh ppd is postive that becomes a visit with copay becasue you need to do work explaing ordering w/u of course.ONe issue here is HOW the insurance and billing owrk Which others on this list serv know better than I But th eother issue is how you serve the patietn YOu make mor eloyality among patients when you sevre their agenda firs.t If she wants the skin procedure to be done -do it for herOther caveats PPD is only good for 30 days after you use it once Good chance you will have ot toss it and buy more before you need it agian MAke sure your cost covers the whole vial. ALso When patietns enter your office is the best time to tell them that if insurance does not cover a procedure and I always state the likley time for that is with cosmetic procedures ,and then when they are requesteing something that is obvioulsy cosmetcitic, I warn t hem again a nd I tell them my cost I cann't recommedn the hassle and likley lies you get when calling insurance That is not your responsibility it is the patietnsWhen we are allied with patietns they can take on these tasks When we are seen to be here to serve not to figure out how many copays to get, we keep them and serve them better, and our practices grow 2 cents. minus 12 agian I have hot water thooght(new yesterday)Jean Thanks for your input. So should I call the insurance company to see if they will cover the cpt for ppd and if the pt owes a copay? Doing the two procedures on separate days makes sense. Just a hassle for the patient though. Are we expected to routinely prior authorize derm lesion excision/biopsy with the insurance company prior to services? Nita To: Sent: Tuesday, January 20, 2009 10:25:56 PMSubject: RE: (unknown) Nita: May I suggest you place PPD on one day and have her return 48 hours later for reading and the skin procedure? I would actually have her pay the co-pay both times…but that is just me. Some insurance requires the co-pay every time a patient is seen; it is part of the patient's contract…(and yours if you are in network) On the other hand, I do not ever charge for the reading of a PPD as long as it is negative. I think if you do both on one day there is that always present risk that the insurance will cover the "lesser" of the two fees, especially if they do not honor a 25 modifier. Depending on your willingness to take that risk, you will want to use the modifier for "separate and identifiable service" on same day. Finally, if PPD is being placed for employment purposes only, some insurers will also deny coverage for that purpose. (non medically necessary) Ramona Ramona G. Seidel, MD www.baycrossingfami lymedicine. com Your Bridge to Health NOTE NEW ADDRESS AND PHONE NUMBER: 269 Peninsula Farm Road Suite F Arnold, MD 21012 410 518-9808 From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of Dr Levin Sent: Tuesday, January 20, 2009 10:17 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA [Practiceimprovemen t1] (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks.. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>>It should not be 99211If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+of course you can do non-nurse workwhy would I want to not code as good as possible? When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquireI should be paid for that.I would code PPD reading as 99212History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on it exam- reading PPda/p- straight complexityor simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it***************************once I had my garbage disposal choked and I had no idea plumber came and push the reset button and voila .......... it started workingso he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days)WHY DO WE DOCTORS UNDERSELL OURSELVES? what is wrong with getting paid for our effort?If we are not being paid well, we are creating a situation which discourages future students to come to medical profession.who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 OK, my turn The cost of a ppd in my office is less than the cost of most co-pays, so then things can get confusing through insurance. For example, if her copay is $20 and UHC allowable is $12.50, then you owe the patient back $7.50. As you can see, things get complex fast. I would place the ppd on the same day I did the skin biopsy with the separate code gave, collect one co-pay, follow up the patient in 48 hours for free reading, and then accept whatever pittance UHC threw in my direction. Losing a patient over $10 is not worth it. Re: [Practiceimprovemen t1] (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA [Practiceimprovemen t1] (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks.. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 ok I did not know about 86580Can I do this;If it is likely to be covered by insurance-- do an E/M visit and place PPD..... E/M is needed b/c I need to evaluate if py has had previous TB, or exposure, pt's nationality, travel, where he lived.......... etc then reading also requires some brain activity.if it is not covered by insurance--- I will go with 86580 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 There have been a lot of discussion on this on the AAFP listservs. Official answer: Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580? A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, " Health examination of defined subpopulations, " may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for " Contact with or exposure to tuberculosis, " 042 for HIV infection or 793.1 for " Nonspecific abnormal findings of radiological and other examination of the lung field. " Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service. In the past. I did not bill for the reading, I assumed it was part of the 86580 code. But when I learned I am entitled and expected to bill for the reading, I started doing it. It is a 99211. You could make it a 99215 if you want to but you don’t need to. None of those questions matter (did it itch, change color, etc). The only thing that matters is how it “feels” (not even looks) at 48-72 hours. Of course if it is positive or questionable then it turns into more than a 1 minute. “Looks good here is your form” and you code appropriately. I bill a 99211 for anything the nurse would do if I had a nurse. I also think it’s important to bill for the reading as the reimbursement for the 86580 does not cover the cost of the vial. I think you have to do 5 PPDs to recoup the cost of the vial and I rarely get that many requests in a 30 day period. I believe I got lucky 10-11 and had a bunch of PPDs and actually will recoup the cost. So the reading charge is actually important at least break even and possibly make a little money on the procedure. It’s not charity. Does the supermarket ever throw in a can of soup? Does the gas station give you a can of oil with your fill-up? Or even a 12 pack of coke. No. Yet, all the time, we are expected and we do, just throw something in for poorly paid work to start with. I have spoken J In the end, we all do what we think is right and we all do it differently. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Pawan Kumar Sent: Wednesday, January 21, 2009 8:08 AM To: Subject: Re: (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>> It should not be 99211 If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+ of course you can do non-nurse work why would I want to not code as good as possible? When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquire I should be paid for that. I would code PPD reading as 99212 History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on it exam- reading PPd a/p- straight complexity or simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it *************************** once I had my garbage disposal choked and I had no idea plumber came and push the reset button and voila .......... it started working so he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days) WHY DO WE DOCTORS UNDERSELL OURSELVES? what is wrong with getting paid for our effort? If we are not being paid well, we are creating a situation which discourages future students to come to medical profession. who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 Ok, confession time…I never really knew you were supposed to discard the vial after 30 days…oops! (I just tossed it when it expired). Does everyone else really toss them after 30 d? A vial costs me $31 and I get $5-$10 from insurance per test. I do maybe 1/month. What do you all do? Gretchen Reis Circleville, OH From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Wednesday, January 21, 2009 8:29 AM To: Subject: RE: (unknown) There have been a lot of discussion on this on the AAFP listservs. Official answer: Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580? A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, " Health examination of defined subpopulations, " may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for " Contact with or exposure to tuberculosis, " 042 for HIV infection or 793.1 for " Nonspecific abnormal findings of radiological and other examination of the lung field. " Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service. In the past. I did not bill for the reading, I assumed it was part of the 86580 code. But when I learned I am entitled and expected to bill for the reading, I started doing it. It is a 99211. You could make it a 99215 if you want to but you don’t need to. None of those questions matter (did it itch, change color, etc). The only thing that matters is how it “feels” (not even looks) at 48-72 hours. Of course if it is positive or questionable then it turns into more than a 1 minute. “Looks good here is your form” and you code appropriately. I bill a 99211 for anything the nurse would do if I had a nurse. I also think it’s important to bill for the reading as the reimbursement for the 86580 does not cover the cost of the vial. I think you have to do 5 PPDs to recoup the cost of the vial and I rarely get that many requests in a 30 day period. I believe I got lucky 10-11 and had a bunch of PPDs and actually will recoup the cost. So the reading charge is actually important at least break even and possibly make a little money on the procedure. It’s not charity. Does the supermarket ever throw in a can of soup? Does the gas station give you a can of oil with your fill-up? Or even a 12 pack of coke. No. Yet, all the time, we are expected and we do, just throw something in for poorly paid work to start with. I have spoken J In the end, we all do what we think is right and we all do it differently. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Pawan Kumar Sent: Wednesday, January 21, 2009 8:08 AM To: Subject: Re: (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>> It should not be 99211 If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+ of course you can do non-nurse work why would I want to not code as good as possible? When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquire I should be paid for that. I would code PPD reading as 99212 History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on it exam- reading PPd a/p- straight complexity or simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it *************************** once I had my garbage disposal choked and I had no idea plumber came and push the reset button and voila .......... it started working so he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days) WHY DO WE DOCTORS UNDERSELL OURSELVES? what is wrong with getting paid for our effort? If we are not being paid well, we are creating a situation which discourages future students to come to medical profession. who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 Yeah, bummer. Right. I really discard the vial in 30ish days. I will sometimes stretch to 32. I try not to do them and then try to find a reason to do many of them once a vial is open. But mostly, we lose money. Just another thing we lose money on. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Gretchen Reis MD Sent: Wednesday, January 21, 2009 11:59 AM To: Subject: RE: (unknown) Ok, confession time…I never really knew you were supposed to discard the vial after 30 days…oops! (I just tossed it when it expired). Does everyone else really toss them after 30 d? A vial costs me $31 and I get $5-$10 from insurance per test. I do maybe 1/month. What do you all do? Gretchen Reis Circleville, OH From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Wednesday, January 21, 2009 8:29 AM To: Subject: RE: (unknown) There have been a lot of discussion on this on the AAFP listservs. Official answer: Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580? A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, " Health examination of defined subpopulations, " may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for " Contact with or exposure to tuberculosis, " 042 for HIV infection or 793.1 for " Nonspecific abnormal findings of radiological and other examination of the lung field. " Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service. In the past. I did not bill for the reading, I assumed it was part of the 86580 code. But when I learned I am entitled and expected to bill for the reading, I started doing it. It is a 99211. You could make it a 99215 if you want to but you don’t need to. None of those questions matter (did it itch, change color, etc). The only thing that matters is how it “feels” (not even looks) at 48-72 hours. Of course if it is positive or questionable then it turns into more than a 1 minute. “Looks good here is your form” and you code appropriately. I bill a 99211 for anything the nurse would do if I had a nurse. I also think it’s important to bill for the reading as the reimbursement for the 86580 does not cover the cost of the vial. I think you have to do 5 PPDs to recoup the cost of the vial and I rarely get that many requests in a 30 day period. I believe I got lucky 10-11 and had a bunch of PPDs and actually will recoup the cost. So the reading charge is actually important at least break even and possibly make a little money on the procedure. It’s not charity. Does the supermarket ever throw in a can of soup? Does the gas station give you a can of oil with your fill-up? Or even a 12 pack of coke. No. Yet, all the time, we are expected and we do, just throw something in for poorly paid work to start with. I have spoken J In the end, we all do what we think is right and we all do it differently. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Pawan Kumar Sent: Wednesday, January 21, 2009 8:08 AM To: Subject: Re: (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>> It should not be 99211 If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+ of course you can do non-nurse work why would I want to not code as good as possible? When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquire I should be paid for that. I would code PPD reading as 99212 History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on it exam- reading PPd a/p- straight complexity or simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it *************************** once I had my garbage disposal choked and I had no idea plumber came and push the reset button and voila .......... it started working so he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days) WHY DO WE DOCTORS UNDERSELL OURSELVES? what is wrong with getting paid for our effort? If we are not being paid well, we are creating a situation which discourages future students to come to medical profession. who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2009 Report Share Posted January 21, 2009 Nita, The patient has to come in twice anyways – once for PPD placement, and once for the read. I’d do the PPD placement, have her come back 2 days later for the ppd reading and skin procedure. Prior Auth will depend on the patient’s insurance – they’re all different. It’s the patient’s responsibility to know if it requires PA – I’d have the patient call her insurance (you can give the patient the CPT code if you want – it may make it easier for her). Or you might be able to look it up online. Most of the insurance companies we’re contracted with have pretty extensive web sites that include what requires PA and what doesn’t and they include the forms to complete. Pratt Office Manager Oak Tree Internal Medicine P.C Roy Medical Associates, Inc. From: [mailto: ] On Behalf Of Nivedita Bijoor Sent: Tuesday, January 20, 2009 10:21 PM To: Subject: Re: (unknown) Thanks for your input. So should I call the insurance company to see if they will cover the cpt for ppd and if the pt owes a copay? Doing the two procedures on separate days makes sense. Just a hassle for the patient though. Are we expected to routinely prior authorize derm lesion excision/biopsy with the insurance company prior to services? Nita From: RGMS <rgms01verizon (DOT) net> To: Sent: Tuesday, January 20, 2009 10:25:56 PM Subject: RE: (unknown) Nita: May I suggest you place PPD on one day and have her return 48 hours later for reading and the skin procedure? I would actually have her pay the co-pay both times…but that is just me. Some insurance requires the co-pay every time a patient is seen; it is part of the patient’s contract…(and yours if you are in network) On the other hand, I do not ever charge for the reading of a PPD as long as it is negative. I think if you do both on one day there is that always present risk that the insurance will cover the “lesser” of the two fees, especially if they do not honor a 25 modifier. Depending on your willingness to take that risk, you will want to use the modifier for “separate and identifiable service” on same day. Finally, if PPD is being placed for employment purposes only, some insurers will also deny coverage for that purpose. (non medically necessary) Ramona Ramona G. Seidel, MD www.baycrossingfami lymedicine. com Your Bridge to Health NOTE NEW ADDRESS AND PHONE NUMBER: 269 Peninsula Farm Road Suite F Arnold, MD 21012 410 518-9808 From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of Dr Levin Sent: Tuesday, January 20, 2009 10:17 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: Re: [Practiceimprovemen t1] (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA ----- Original Message ----- From: Nivedita Bijoor To: Practiceimprovement 1yahoogroups (DOT) com Sent: Tuesday, January 20, 2009 8:49 PM Subject: [Practiceimprovemen t1] (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks.. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 Does anybody know how exactly they come up with these expiration dates on various things like the PPD, xylocaine, immunizations and and biologicals and other medications, such as samples? Is there any actual testing done on them as part of the FDA approval process? Or is it based on somebody's best guess? It has tremendous economic consequences both for us and the patients. > > Yeah, bummer. Right. I really discard the vial in 30ish days. I will > sometimes stretch to 32. > > > > I try not to do them and then try to find a reason to do many of them once a > vial is open. But mostly, we lose money. Just another thing we lose money > on. > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypractice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: > [mailto: ] On Behalf Of Gretchen Reis MD > Sent: Wednesday, January 21, 2009 11:59 AM > To: > Subject: RE: (unknown) > > > > Ok, confession time.I never really knew you were supposed to discard the > vial after 30 days.oops! (I just tossed it when it expired). Does everyone > else really toss them after 30 d? A vial costs me $31 and I get $5-$10 from > insurance per test. I do maybe 1/month. What do you all do? > > > > Gretchen Reis > > Circleville, OH > > > > _____ > > From: > [mailto: ] On Behalf Of Kathy Saradarian > Sent: Wednesday, January 21, 2009 8:29 AM > To: > Subject: RE: (unknown) > > > > There have been a lot of discussion on this on the AAFP listservs. Official > answer: > > > > Q What is the correct ICD-9 code for the purified protein derivative (PPD) > skin test, CPT code 86580? > > A ICD-9 code V74.1 represents a special screening examination for pulmonary > tuberculosis, including diagnostic skin testing for the disease. Often code > V70.5, " Health examination of defined subpopulations, " may be a secondary > diagnosis to indicate the test is performed as part of a pre-employment or > occupational health examination. Additional ICD-9 codes may be reported to > indicate the patient's risk for tuberculosis. For example, report V01.1 for > " Contact with or exposure to tuberculosis, " 042 for HIV infection or 793.1 > for " Nonspecific abnormal findings of radiological and other examination of > the lung field. " > > Remember that when a patient returns for the PPD reading, even when the > reading is done by a nurse working incident to your services, you may report > code 99211 for this evaluation and management (E/M) service. > > > > In the past. I did not bill for the reading, I assumed it was part of the > 86580 code. But when I learned I am entitled and expected to bill for the > reading, I started doing it. It is a 99211. You could make it a 99215 if > you want to but you don't need to. None of those questions matter (did it > itch, change color, etc). The only thing that matters is how it " feels " > (not even looks) at 48-72 hours. Of course if it is positive or > questionable then it turns into more than a 1 minute. " Looks good here is > your form " and you code appropriately. I bill a 99211 for anything the > nurse would do if I had a nurse. > > I also think it's important to bill for the reading as the reimbursement for > the 86580 does not cover the cost of the vial. I think you have to do 5 > PPDs to recoup the cost of the vial and I rarely get that many requests in a > 30 day period. I believe I got lucky 10-11 and had a bunch of PPDs and > actually will recoup the cost. So the reading charge is actually important > at least break even and possibly make a little money on the procedure. It's > not charity. Does the supermarket ever throw in a can of soup? Does the > gas station give you a can of oil with your fill-up? Or even a 12 pack of > coke. No. Yet, all the time, we are expected and we do, just throw > something in for poorly paid work to start with. I have spoken J > > In the end, we all do what we think is right and we all do it differently. > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypractice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > > > From: > [mailto: ] On Behalf Of Pawan Kumar > Sent: Wednesday, January 21, 2009 8:08 AM > To: > Subject: Re: (unknown) > > > > <<you are entitled to a 99211 for the reading if you actually have to read > it and sign off on it being negative.>> > > It should not be 99211 > If a doctor even looks at patient---ie anything more than a nurse and nurse > only visit-- can be 99212+ > of course you can do non-nurse work > > why would I want to not code as good as possible? > > When I am reading PPD, I am investing my time and I am using a skill that > took time, effort and certain qualification to acquire > I should be paid for that. > > I would code PPD reading as 99212 > History- did you have any trouble, does it itch, did it change red in color, > did you apply any cosmetic/medication/chemical on it > exam- reading PPd > a/p- straight complexity > > or simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely > to be truthful so I would avoid it > > > *************************** > once I had my garbage disposal choked and I had no idea > plumber came and push the reset button and voila .......... it started > working > so he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in > those days) > > WHY DO WE DOCTORS UNDERSELL OURSELVES? > > what is wrong with getting paid for our effort? > If we are not being paid well, we are creating a situation which discourages > future students to come to medical profession. > who will take care of me when I am old? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 why would you not charge copay for trhe ppd placement. the insurance company is going to list the copay as the patients responsibiligty when you bill that visit. Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Tuesday, January 20, 2009 10:16:37 PMSubject: Re: (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 When we filed claims, we found that the insurance company dedcuted the patients copay from both the ppd placement and the reading. So we have them pay the copay for both. Sometimes they argue, and so Alice sends me out to talk with them (Danger! Will ! Madman coming!) I explain that it is their insurance company's rules , and in our contract we are not allowed to waive the copay. Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Tuesday, January 20, 2009 10:25:56 PMSubject: RE: (unknown) Nita: May I suggest you place PPD on one day and have her return 48 hours later for reading and the skin procedure? I would actually have her pay the co-pay both times…but that is just me. Some insurance requires the co-pay every time a patient is seen; it is part of the patient’s contract…(and yours if you are in network) On the other hand, I do not ever charge for the reading of a PPD as long as it is negative. I think if you do both on one day there is that always present risk that the insurance will cover the “lesser” of the two fees, especially if they do not honor a 25 modifier. Depending on your willingness to take that risk, you will want to use the modifier for “separate and identifiable service” on same day. Finally, if PPD is being placed for employment purposes only, some insurers will also deny coverage for that purpose. (non medically necessary) Ramona Ramona G. Seidel, MD www.baycrossingfamilymedicine.com Your Bridge to Health NOTE NEW ADDRESS AND PHONE NUMBER: 269 Peninsula Farm RoadSuite F Arnold, MD 21012 410 518-9808 From: [mailto: ] On Behalf Of Dr LevinSent: Tuesday, January 20, 2009 10:17 PMTo: Subject: Re: (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA [Practiceimprovemen t1] (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 This is what we do on a negative. 99211 with a ICD code V74.1 (I think. I know its a V74.? code.) Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Wednesday, January 21, 2009 8:08:20 AMSubject: Re: (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>>It should not be 99211If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+of course you can do non-nurse workwhy would I want to not code as good as possible?When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquireI should be paid for that.I would code PPD reading as 99212History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on itexam- reading PPda/p- straight complexityor simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it***************************once I had my garbage disposal choked and I had no ideaplumber came and push the reset button and voila .......... it started workingso he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days)WHY DO WE DOCTORS UNDERSELL OURSELVES?what is wrong with getting paid for our effort?If we are not being paid well, we are creating a situation which discourages future students to come to medical profession.who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 I just verified this. When they get the ppd read, we code 99211 with V74.1 as an ICD. Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Wednesday, January 21, 2009 8:08:20 AMSubject: Re: (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>>It should not be 99211If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+of course you can do non-nurse workwhy would I want to not code as good as possible?When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquireI should be paid for that.I would code PPD reading as 99212History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on itexam- reading PPda/p- straight complexityor simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it***************************once I had my garbage disposal choked and I had no ideaplumber came and push the reset button and voila .......... it started workingso he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days)WHY DO WE DOCTORS UNDERSELL OURSELVES?what is wrong with getting paid for our effort?If we are not being paid well, we are creating a situation which discourages future students to come to medical profession.who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 I charge $25 for a ppd (which includes the recheck), i usu pay about that much for a vial, i always get a few so i don't ahve to order again in 30 days, and when i first went out on my own my neurosis made me read teh package insert, so now i throw it out when it's 30 days open (there's a little line on the bottle to write the date), but i always make sure that i'm up to date, and that there's noone in the schedule for a week later for a ppd, i'll bring them in before it expires! tac Yeah, bummer. Right. I really discard the vial in 30ish days. I will sometimes stretch to 32. I try not to do them and then try to find a reason to do many of them once a vial is open. But mostly, we lose money. Just another thing we lose money on. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Gretchen Reis MD Sent: Wednesday, January 21, 2009 11:59 AMTo: Subject: RE: (unknown) Ok, confession time…I never really knew you were supposed to discard the vial after 30 days…oops! (I just tossed it when it expired). Does everyone else really toss them after 30 d? A vial costs me $31 and I get $5-$10 from insurance per test. I do maybe 1/month. What do you all do? Gretchen Reis Circleville, OH From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Wednesday, January 21, 2009 8:29 AMTo: Subject: RE: (unknown) There have been a lot of discussion on this on the AAFP listservs. Official answer: Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580? A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, " Health examination of defined subpopulations, " may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for " Contact with or exposure to tuberculosis, " 042 for HIV infection or 793.1 for " Nonspecific abnormal findings of radiological and other examination of the lung field. " Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service. In the past. I did not bill for the reading, I assumed it was part of the 86580 code. But when I learned I am entitled and expected to bill for the reading, I started doing it. It is a 99211. You could make it a 99215 if you want to but you don't need to. None of those questions matter (did it itch, change color, etc). The only thing that matters is how it "feels" (not even looks) at 48-72 hours. Of course if it is positive or questionable then it turns into more than a 1 minute. "Looks good here is your form" and you code appropriately. I bill a 99211 for anything the nurse would do if I had a nurse. I also think it's important to bill for the reading as the reimbursement for the 86580 does not cover the cost of the vial. I think you have to do 5 PPDs to recoup the cost of the vial and I rarely get that many requests in a 30 day period. I believe I got lucky 10-11 and had a bunch of PPDs and actually will recoup the cost. So the reading charge is actually important at least break even and possibly make a little money on the procedure. It's not charity. Does the supermarket ever throw in a can of soup? Does the gas station give you a can of oil with your fill-up? Or even a 12 pack of coke. No. Yet, all the time, we are expected and we do, just throw something in for poorly paid work to start with. I have spoken J In the end, we all do what we think is right and we all do it differently. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Pawan Kumar Sent: Wednesday, January 21, 2009 8:08 AMTo: Subject: Re: (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>>It should not be 99211If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+ of course you can do non-nurse workwhy would I want to not code as good as possible?When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquire I should be paid for that.I would code PPD reading as 99212History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication/chemical on itexam- reading PPd a/p- straight complexityor simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it***************************once I had my garbage disposal choked and I had no idea plumber came and push the reset button and voila .......... it started workingso he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days)WHY DO WE DOCTORS UNDERSELL OURSELVES? what is wrong with getting paid for our effort?If we are not being paid well, we are creating a situation which discourages future students to come to medical profession.who will take care of me when I am old? -- Crowley, MD Family MedicineCape May Courthouse NJPatients, please allow up to 48 hours for response. If you are having an urgent problem please go to the emergency department or call 911. If you have a problem or question that can't wait 48 hours, or you have not received a timely response, just call the office at 465-0882. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 You're supposed to toss the vial after 30 days? uh oh Wayne CoghillPractice ManagerMidtown Primary Carewww.doctorcoghill.com To: Sent: Wednesday, January 21, 2009 11:58:32 AMSubject: RE: (unknown) Ok, confession time…I never really knew you were supposed to discard the vial after 30 days…oops! (I just tossed it when it expired). Does everyone else really toss them after 30 d? A vial costs me $31 and I get $5-$10 from insurance per test. I do maybe 1/month. What do you all do? Gretchen Reis Circleville, OH From: [mailto: ] On Behalf Of Kathy SaradarianSent: Wednesday, January 21, 2009 8:29 AMTo: Subject: RE: (unknown) There have been a lot of discussion on this on the AAFP listservs. Official answer: Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580? A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, "Health examination of defined subpopulations," may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for "Contact with or exposure to tuberculosis," 042 for HIV infection or 793.1 for "Nonspecific abnormal findings of radiological and other examination of the lung field." Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service. In the past. I did not bill for the reading, I assumed it was part of the 86580 code. But when I learned I am entitled and expected to bill for the reading, I started doing it. It is a 99211. You could make it a 99215 if you want to but you don’t need to. None of those questions matter (did it itch, change color, etc). The only thing that matters is how it “feels” (not even looks) at 48-72 hours. Of course if it is positive or questionable then it turns into more than a 1 minute. “Looks good here is your form” and you code appropriately. I bill a 99211 for anything the nurse would do if I had a nurse. I also think it’s important to bill for the reading as the reimbursement for the 86580 does not cover the cost of the vial. I think you have to do 5 PPDs to recoup the cost of the vial and I rarely get that many requests in a 30 day period. I believe I got lucky 10-11 and had a bunch of PPDs and actually will recoup the cost. So the reading charge is actually important at least break even and possibly make a little money on the procedure. It’s not charity. Does the supermarket ever throw in a can of soup? Does the gas station give you a can of oil with your fill-up? Or even a 12 pack of coke. No. Yet, all the time, we are expected and we do, just throw something in for poorly paid work to start with. I have spoken J In the end, we all do what we think is right and we all do it differently. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Pawan KumarSent: Wednesday, January 21, 2009 8:08 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] (unknown) <<you are entitled to a 99211 for the reading if you actually have to read it and sign off on it being negative.>>It should not be 99211If a doctor even looks at patient---ie anything more than a nurse and nurse only visit-- can be 99212+of course you can do non-nurse workwhy would I want to not code as good as possible?When I am reading PPD, I am investing my time and I am using a skill that took time, effort and certain qualification to acquireI should be paid for that.I would code PPD reading as 99212History- did you have any trouble, does it itch, did it change red in color, did you apply any cosmetic/medication /chemical on itexam- reading PPda/p- straight complexityor simply-- 5 of 10 minutes spent on c/c at this visit--- this is unlikely to be truthful so I would avoid it************ ********* ******once I had my garbage disposal choked and I had no ideaplumber came and push the reset button and voila .......... it started workingso he charges me 75$ PLUS sales tax PLUS gas surcharge (gas rates were up in those days)WHY DO WE DOCTORS UNDERSELL OURSELVES?what is wrong with getting paid for our effort?If we are not being paid well, we are creating a situation which discourages future students to come to medical profession.who will take care of me when I am old? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 We wouldn’t charge a copay because all we bill is the PPD placement and not an E & M code (unless of course the PPD is placed along with some other reason for the visit – followup for chronic condition, for example). If you only bill the ICD9 for the PPD placement with the E & M code, insurance will deny the E & M (at least that’s been my experience). We will now start charging for the reading as a 99211 (read by the nurse), though, and collect a copay then. Thanks to whomever posted that they do that with the AAFP documentation! Pratt Office Manager Oak Tree Internal Medicine P.C Roy Medical Associates, Inc. From: [mailto: ] On Behalf Of Wayne Coghill Sent: Thursday, January 22, 2009 12:04 PM To: Subject: Re: (unknown) why would you not charge copay for trhe ppd placement. the insurance company is going to list the copay as the patients responsibiligty when you bill that visit. Wayne Coghill Practice Manager Midtown Primary Care www.doctorcoghill.com From: Dr Levin <dr_levincomcast (DOT) net> To: Sent: Tuesday, January 20, 2009 10:16:37 PM Subject: Re: (unknown) Have her come in for PPD placement, but don't charge copay for that. Come another time for the skin biopsy. I often may have pt come back for immunization later, like a flu shot I wouldn't charge the copay just for that. Matt in Western PA (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2009 Report Share Posted January 23, 2009 Give PPD placement at same time as a physical; copay is for THAT (unknown) Dear all, I have an established patient coming in for a skin lesion removal in a few wks. She called stating that she needs a ppd placed for Tb testing and wanted to get both, the skin procedure and ppd placement done at same visit to avoid 2 copays. This is my first ppd placement in my new practice and I was wondering.. Do insurance companies pay for 2 different CPT on same date of visit? (insurance company in this case is United UHC) Also, should one collect a copay for ppd visit & /or when patient comes back for reading? What is the right way to do this...is the ppd visit considered an office visit..99211 or 99212? I appreciate your help on this one! Nita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 17, 2012 Report Share Posted July 17, 2012 Sorry! Â My e-mail was hacked- I did not send the previous message. Â I have fixed the problem. ________________________________ To: polymicrogyria ; participant@...; amandahastings@... Sent: Tuesday, July 17, 2012 10:01 AM Subject: (unknown) Â http://www.originalquakerhouse.com/wpstore/wp-content/plugins/zjpejofebly/test.p\ hp?lovely223.png Quote Link to comment Share on other sites More sharing options...
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