Resolved Questions about the practice CPC test

[RinshidaK_89540]

Question:
Jennifer Lawson
Hi,
I would like to address these questions to Laureen, but welcome input from everyone.
This is from the 2012 practice test but we are attempting to get better at answering the questions correctly within the given amount of time.

Question #147
The answer key indicates that code 90966 would not be correct because it is used for physicians only. I find nothing in the CPT book either in the code description or the guidelines that says this code has this restriction.

Can anyone shed any light on this for me?
Thanks
Jennifer

Answer Thread:
Laureen
Hi Jennifer - can you post the entire question and rationale here. I agree that 90966 is not limited to physicians only but you can't use it in an inpatient setting - - so perhaps that is what the question was testing you on.

Quote from CPC Guidelines:

Codes 90963-90966 are reported once per month for a full month of service to distinguish age-specific services for end-stage renal disease (ESRD) services for home dialysis patients.

For ESRD and non-ESRD dialysis services performed in an inpatient setting, and for non-ESRD dialysis services performed in an outpatient setting, see 90935-90937 and 90945-90947.

Jennifer Lawson
Hi Laureen,
Thanks for your reply. Here is the question and rationale:

147. A 73 year old group home resident with end stage renal disease has a nurse come in on Mondays, Wednesdays, and Fridays to perform peritoneal dialysis. Each dialysis session lasts three hours. Once a week, (on Friday), the nurse also assists the patient with his meals, cleaning, and grocery shopping. What should the nurse charge for a month (30 days) of services if the 1st of the month landed on a Monday?

1. 99601, 99602 x25, 99509 x4
2. 99601 x13, 99602 x13, 99509 x4
3. 90966, 99509 x4
4. 99512 x 13, 99509 x4

147. B – The simplest way to code this would be to code for one day and then just multiple that for the number of visits in the month. When coding for a single day you would use code 99601 as the initial peritoneal infusion code and code 99602 for the additional hour. These codes would be used on all three days the nurse visits and code 99509 would be added on once each week for the additional services performed on Fridays. Code 90966 would not be correct because this code is only for physician use (not nurses). Code 99512 is also incorrect because this code is for hemodialysis and not peritoneal dialysis. Beneath this code there is even a notation stating that if coding for home infusion of peritoneal dialysis to use codes 99601 and 99602. The number of Mondays, Wednesdays, and Fridays in the month add up to 13. It would be incorrect to code one initial infusion code (99601) and the rest of the visits as code (99602 x25), because code 99601 states that it should be used “per visit”. This means that code 99601 should be used for each individual date of service with the add-on code 99602 for each date of service. (99601 x13 and 99602 x13). In a month there were also 4 Fridays and so code 99509 would be coded as 99509 x4.

Thank you,
Jennifer