Use of a Scribe

Question:

We are hiring a scribe for the doctor because it will help improve his documentation.  Is there anything we need to know about how to document this?

Answer:

Yes, absolutely. This situation should be clearly delineated so a third-party reviewer can identify the provider who performed the service, and the record should be signed by both parties (the scribe and physician).

Remember, a scribe does not ask the patient any questions, nor does a scribe do an examination of the patient. A scribe merely records the information obtained by a provider. Bottom line is that a nurse practitioner or physician assistant generally does not act as a scribe.

Example of statements:

I, (scribe name), am serving as a scribe to document services personally performed by (physician name), based on my observation and the provider’s statements to me.

and

I, (physician name), attest that (scribe name) is acting in a scribe capacity, has observed my performance of the services, and has documented them in accordance with my direction.

*This response is based on the best information available as of 02/10/22.

Telehealth Licensure Requirements

Question:

We live in a northern state and frequently have patients who travel to warmer clients during the winter.  Are you able to directly me to information on state licensure requirements for Telehealth services?

Answer:

Yes, you will now find this list on the KZA Telehealth Solution sitehttps://karenzupko.com/KZA-telehealth-solution-center. Look for the tab that says, “Licensure Requirements –New”.

*This response is based on the best information available as of 01/27/22.

Fractional Laser Therapy

Question:

We are going to be doing laser therapy for hypertrophic burn scars.  From my understanding we will be using fractional ablative CO2 laser therapy.

Answer:

There are 2 category III codes to report this procedure, 0479T and 0480T. CPT code 0479T is reported for the first 100 cm2 or part thereof, or 1% of body surface area of infants and children and 0480T is the add-on code for each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof. These codes were added in 2018. If the payor does not accept Category III codes, you would report the unlisted code 17999 and submit documentation to the payor for reimbursement. It might be a good idea to check with your individual payors to see if this procedure is covered and if preauthorization is required.

*This response is based on the best information available as of 11/11/21.

Coding an Epidermal Inclusion Cyst

Question:

I excised an EIC lesion on the chest.  I coded this as D48.5 but my coder says this is the wrong diagnosis code.  What is the correct diagnosis code?

Answer:

ICD-10-CM code D48.5 (Neoplasm of uncertain behavior of skin) is incorrect as you have stated the patient has an EIC (epidermal inclusion cyst). You should report L72.0,(Epidermal cyst).

*This response is based on the best information available as of 4/1/21.

Excision of Rheumatoid Nodules

Question:

I excised a rheumatoid nodule on both the left and right elbow.  What CPT code do I report?

Answer:

You would report CPT code 24120 (excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process).  You can report this procedure when performed bilaterally. Make sure you report the excision on both the right and left elbows with either Modifier 50 or RT, LT depending on what the payor allows.

*This response is based on the best information available as of 2/4/21.

Wedge Excision with Reconstruction

Question:

My physician did a full thickness wedge excision with an Estlander flap of the right upper lip with reconstruction utilizing a cheek flap, adjacent tissue transfer. The defect measures 27 sq. cm. The physician used a mucosal graft from the wedge excised from the lip with reconstruction of the vermillion of the right upper lip. I am not sure what CPT code I should use?

Answer:

You should use CPT code 40525 when the physician removes a full thickness portion of the lip with local flap reconstruction. A “V” incision may be made around the lesion and through the full thickness of the lip. The lesion and surrounding tissues are removed. A local skin flap is incised and advanced to the site of the surgical wound and sutured into place with layered closure.

*This response is based on the best information available as of 12/17/20.