First of all, I"m not a certified coding compliance officer, so these are just my opinions. With that said, a reader poses the question:
A couple of comments here. First of all, the 99105 code requires you to place the NG in order to aspirate or lavage. If you are placing an NG for tube feeds or to give meds, I'm not sure this code would suffice. I have no idea what the code would be to get paid for placing an NG to give meds or tube feeds.I have a few questions about CPT® medical coding. I work as a Physician assistant hospitalist in xxxx. My employer is asking me to bill certain codes but don't think they are appropriate. Please let me know what you think.
In my facility, nurses do not place NG tubes but we do. The company wants me to bill 91105 (gastric intubation, and aspiration or lavage for treatment, ie ingested poisons). and a subsequent visit 99231( low level hospital follow up visit). for the visit. I am ok with the 91105 code but to bill the subsequent visit to evaluate the patient for the need of an NG tube does not make sense. First of all, sometimes GI doctors put in the order to place an NG tube so why should I evaluate the pt for an NG tube.
The other question is the company wants me to bill for monitoring patients getting CT with IV contrast. In NY, I guess there is a law that a patient getting IV contrast has to be monitored just to make sure they don't have a reaction. This would also be a subsequent 99231 billing.
As for the billing of a follow up note 99231 in order to make a determination on whether an NG is appropriate, I have no problem with this. When I ask my gastroenterologists to do an EGD for an upper GI bleed, they do a full, level five consult 100% of the time and because they are the ones making the decision on whether to do the EGD or not, they have every right to charge a consult note.
Now, when I order a CT guided lung biopsy by they interventional radiologist, they never do a consult note. But they could if they structured their group to do one.
Sometimes when I get asked to put in a central line by another service, I could, If I wanted to, do a complete consult note and then bill the procedure note. I don't because I find it ridiculous, like you.
But I could and it would be medically necessary. In fact, you could probably bill a consult level code and get paid for it everytime you were asked to put in an NG since you need to evaluate the patient first, just like the GI docs do for EGD, just like the cardiologists do for cath, just like the surgeons do for surgeries.
As for the billing while monitoring IV contrast, again, you could probably bill a full consult note if you wanted to take the time to do it. Remember, a consult requires the 3 Rs
1) Document the requesting physician (Dr X)2) Document the reason (Evaluate the safety of IV contrast administration)3) Document the response back (Usually a dictation).
Now, you could choose to do just a follow up code and the Medicare National Bank would be glad to pay you less. But I suspect you could probably bill something higher than a level one. Remember, It doesn't take much to get a 99232. If they have renal insufficiency, you might even be able to bill a 99233 if your documentation supports it.
If you are spending time doing anything, even if it involves using a vein light to get IV access and monitoring IV contrast or or putting in an NG, you should get paid, or your employer should get paid for your services. Thus is the nature of fee for service.
You can learn more about coding for free in my lectures on medical billing and coding.
