Office Management

Billing for physician review of abnormal test results

Posted February 10, 2014

Please recommend a CPT code to fit this service if available: 

This charge is generated from the physician's review of abnormal testing or lab results.  The physician indicates any changes to the treatment plan or authorizes proceeding with treatment based on the outcome of that testing. This allows the patient to move forward with treatment without the cost of an additional consult with the physician. Usual physician time is 5-15 minutes and the phone call to the patient is done by a nurse.

Coding for the infertility testing phase

Posted February 10, 2014

We have been using a testing diagnosis code V26.21 and are being told by insurance companies that this code is invalid. Do you have other diagnosis codes that are used during the testing phase?

Appropriate coding for nursing staff interaction and cycle management conferences during ovulation-induction cycles

Posted December 17, 2013

We are considering the use of CPT code 99211 for encounters during cycle management as part of ovulation induction. Nursing staff meets with the patient after ultrasounds are performed and blood work is drawn. Ultrasound results are discussed with the patient at that time. All results are discussed with the physician who is in the office. The nursing staff contacts the patient later in the afternoon after the blood work results are complete. Is this an appropriate use of this E+M code?

Can we submit team-management CPT codes per patient for daily cycle-management conferences that determine ongoing treatment during the cycle? Do those codes require more significant amounts of time spent than the few minutes per patient that are spent? 

Coding education and teaching for injectable medications

Posted December 10, 2012

Our clinic is having difficulty with the codes we are using for education and injection classes.  Typically, we will do the medication outline (letrozole, clomiphene) over the phone with one of our nursing staff members, and the injection class in the office with a nurse. 
Currently, we are coding the classes as:

  • 98968 - Medication outline
  • 98960 – Injection class

Is there a modifier that should be used if these two classes are done in the same visit?

CPT Codes for Telephone Calls

Posted June 15, 2009

Can you please clarify the intent of the CPT codes for telephone calls? Specifically, I am interested in understanding when it would be appropriate to use the CPT codes 99371, 99372, and 99373. Most reproductive clinicians routinely coordinate medical management or have regular contact with their patients, either directly or indirectly by phone, multiple times during an ART or IUI/FSH cycle. Is it appropriate to bill for these calls in association with ren­dering daily test results (E2, ultrasounds, etc.), advising patients of daily gonadotropin dosages, answering routine questions and/or discussing future plans? Or, is it not appropriate to bill separately for these items as they are part of routine infertility care?

Telephone Consult

Posted June 15, 2009

Does a physician need to speak directly to a patient to code for a telephone consult (99371-99373) or can a physician give specific instructions to a staff member to relay to patients? Patients can be difficult to contact, and physicians have limited time during the day. For example, if a nurse relays information that a pregnancy test is negative and that the patient should start her BCP on Sunday, would this be appropriate to code as 99371?

Patient Education

Posted June 15, 2009

What is the correct way to bill and receive payment for the patient education sessions performed by registered nurses to individual patients prior to their IVF cycle? We typically spend at least one hour with each patient and partner discussing instructions and protocol for their ovulation induction.

Initial New Patient Consultation as Opposed to Being Referred by another physician

Posted June 15, 2009

If we have a patient who self-refers to our physician for an initial new patient consultation as opposed to being referred by another physician, how do we code for the consult? Also, when our physician brings the patient back into the office for a follow-up consultation to discuss diagnostic results and treatment recommendations, how do we code? Both of these consultations include approximately one hour of face-to-face time with the physician.

Recurrent Miscarriages

Posted June 15, 2009

Our reproductive endocrinologist sees patients for recurrent miscarriages. When he sees the patient for the first visit, is it appropriate to use the diagnosis codes V26.4 (procreative management) as a primary code and 629.9 as a secondary code?

Initial Visit for Infertility

Posted June 15, 2009

What code would be appropriate for an initial visit for infertility? Our practice is in a state where there is no mandated coverage for infertility. We are finding that many insurances will not cover if the word “infertility” is used.

Nurse Practitioner Seeing a Fertility Patient

Posted June 15, 2009

What code is used for a nurse practitioner seeing a fertility patient for the first time?

New Infertility Patient

Posted June 15, 2009

How soon can you bill as a new infertility patient? If a patient has not been seen since 2004 for infertility and is now returning for infertility in 2006, would they be considered a new patient? What is the time frame to bill again as a new patient?

ASC Bill Third-party Payors a Facility Fee

Posted June 15, 2009

If an IVF embryo extraction and transfer is performed at an ambulatory surgical center (ASC), can the ASC bill third-party payors a facility fee? Can they bill such a fee in addition to what the IVF physician and the embryology lab may bill?

Bill a Facility Fee

Posted June 15, 2009

Can a privately owned office facility dedicated to IVF services and embryology lab bill a facility fee to insurance companies?


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