I work at a primary care office, and we recently hired a PA with a background in ortho. She is going to start seeing patients for Falls Risk Assessments. I’m a little stuck as to the best way to bill these. They are full assessments – physical, vision, and cognitive exams, potential hazards and risk factors, balance and gait assessments, etc – and she’ll generally be spending 60+ minutes with the patient. Because they are such extensive visits, we were hoping to bill something other than a general office visit code, but I’m coming up empty-handed. I’m leaning toward billing a 99215, and if she spends enough time, adding a prolonged services code. (We’ve discussed she needs to focus on documenting her counseling/coordination and medical necessity to substantiate this). I still have to wonder if there’s a better option out there – does anyone here have any thoughts?
I’m also wondering what ICD-10 codes I should be using. The bulk of the patient she sees will be Medicare, and the code she wants to use is Z91.81, "At risk for falling," since the idea is to catch people BEFORE they start falling. Obviously, Medicare won’t accept this as a primary diagnosis, but I’m at a loss as to what else I can use. Some of the patients may have specific conditions that are the main risk she’s assessing, but not all of them.
Thanks!
Christie Anna