CPT Code 33211: What It Is, Modifiers, Reimbursement - 33211

2024-08-21 11:51:32

The cost of a new car wheel bearing can vary depending on several factors, including the make and model of your vehicle, the location of the bearing, and whether you purchase an original equipment manufacturer part.

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A 46-year-old established patient, who was seen six months ago for a health maintenance visit, is in overall good health and is within 10 percent of his ideal body weight, comes to your office to discuss a diet and exercise program. The patient is now interested in a regular exercise program and diet to reduce his risk of cardiovascular disease since his 52-year-old brother recently had a heart attack. You spend 15 minutes discussing these issues with him. You should submit the appropriate preventive medicine counseling code for this visit and ICD-9 codes V65.3 and V65.41. BillDiagnosis code(s)Procedure code(s)PatientV65.3Dietary surveillance and counseling99401Preventive medicine counselingV65.41Exercise counseling

Wear and tear: Over time, bearings can wear out due to constant use and exposure to various road conditions. When they become worn, the metal balls or rollers inside may lose their smoothness, causing friction and generating noise.

Keep in mind that if you're replacing a wheel bearing, it's usually recommended to replace both bearings on the same axle simultaneously, even if only one is showing signs of wear or damage.

Replacing a car wheel bearing typically involves several steps and requires some mechanical knowledge and tools. Here's a general overview of the process:

Note that the work associated with performing the history, examination and medical decision making for the problem-oriented E/M service will likely overlap those performed as part of the comprehensive preventive service to a certain extent. Therefore, the E/M code reported for the problem-oriented service should be based on the additional work performed by the physician to evaluate that problem. An insignificant or trivial problem or abnormality that does not require performance of these key components should not be reported separately from the preventive medicine service.

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Specific preventive medicine services for a 25-year-old healthy female will be very different from those for a 55-year-old male and even a 55-year-old female, but the general components of a preventive medicine visit according to CPT’s preventive medicine services codes (99381-99397) remain the same:

Lack of lubrication: Adequate lubrication is crucial for the smooth operation of a wheel bearing. If the bearing is not properly lubricated or the lubricant has deteriorated over time, it can result in increased friction and noise.

Preventive care is a cornerstone of family medicine. Routine visits for patients of all ages are scheduled to promote wellness and disease prevention. These visits can also include additional services, such as vaccinations, screening laboratory services, counseling and even management of medical problems. Understanding how to code and be reimbursed for all of these services can be challenging, especially since third-party payers’ reimbursement policies on preventive services vary.

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A common issue for most car owners relates to the car wheel bearings. But what are they? Why are they important? And can you replace them yourself?

As a rough estimate, the price for a single wheel bearing can range from £150 to £250. However, this is only an approximate range, and the actual cost can be higher or lower depending on the factors mentioned above.

Medicare does not provide reimbursement for CPT’s comprehensive preventive medicine services codes described above, but because of the Balanced Budget Act of 1997, it does provide reimbursement for certain screening services provided in the absence of an illness, disease, sign or symptom, such as a screening pelvic and clinical breast exam.

Reporting both preventive and problem-oriented services on the same date can often lead to inconsistent results. While some payers will reimburse the full allowable amount for both the problem-oriented E/M code and the preventive medicine services code, some will assess a co-pay for each service, some will carve out the reimbursement for the problem-oriented E/M service from the payment for the preventive exam (which results in a total charge that does not exceed that of a comprehensive preventive examination alone), and some will simply deny the claim on the basis that they do not accept coding for both a preventive and problem-oriented service on the same date regardless of the amount of the charge because, they say, you’re billing twice for the portions of the preventive and problem-oriented services that overlap.

The car wheel bearings are located within the wheel hub assembly. This is the part that connects the wheel to the vehicle's suspension system.

Although the decision to order immunizations or laboratory/diagnostic procedures is part of the preventive medicine service, the actual performance of those services should be billed separately. Therefore, if you provide an immunization or perform the laboratory study in your office, you should bill the services in addition to the preventive E/M visit.

Understanding how preventive medicine coding works can help you to accurately distinguish wellness and disease-prevention services from problem-oriented ones in your coding. This will not only improve your reimbursement but also will allow you to track the preventive services provided by your practice so that you are always aware of the health maintenance services due for each patient.

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Insignificant problems may be addressed as part of a preventive visit. For example, a patient seen in the spring or fall might request a prescription renewal for allergy medications. Unless significant work is required to assess this complaint, writing the prescription is included in the preventive medicine services code submitted for the visit. (See the example of a standard preventive E/M visit.)

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Contamination: Dirt, debris, or water can enter the wheel bearing and cause contamination. This can accelerate wear and create noise as the foreign particles interfere with the smooth rotation of the bearing.

Keeping on top of regular car maintenance and getting your car serviced can help avoid this issue affecting your vehicle.

Common signs of a failing wheel bearing include unusual noises such as grinding or humming coming from the wheel, vibration, uneven tyre wear, and excessive play or looseness in the wheel.

Excessive load or impact: Intense driving conditions, such as carrying heavy loads or encountering potholes and impacts, can put additional stress on the wheel bearing. This can lead to damage, wear, and ultimately noise.

It is highly recommended to consult your vehicle's repair manual, call a mobile mechanic or seek professional assistance from a local garage.

A 28-year-old established patient comes to your office for her well-woman examination. You take the patient’s interval medical, family and social history and perform a complete review of systems. You also perform a physical examination that includes a blood-pressure check and thyroid, breast, abdominal and pelvic examinations, and you obtain a Pap smear. The patient is on oral contraceptives and has concerns about intermittent break-through bleeding. You counsel the patient regarding alternatives and give her a prescription for a new medication. You also counsel the patient about diet, exercise, substance abuse and sexual activity. Then you send the Pap smear to an outside laboratory that will bill the test directly to the payer. Although the patient has concerns about her current method of birth control, the associated counseling and change in medication is considered part of the preventive medicine service for her age group, so you should submit 99395, “Periodic comprehensive preventive medicine ..., established patient; 18-39 years,” and ICD-9 code V72.3, “Gynecological examination.” BillDiagnosis code(s)Procedure code(s)PatientV72.3Gynecological examination99395Preventive service

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This table lists some of the preventive screening services that are covered by Medicare. It shows the covered frequency and the associated HCPCS and ICD-9 codes that should be submitted for each service. (For information about other Medicare-covered screening services, go to http://www.medicare.gov/health/overview.asp.) Screening serviceFrequencyHCPCS codeICD-9 codeScreening pelvic and clinical breast examOnce every 2 years; once every year for high-risk patients*G0101V76.2, V76.47, V76.49 or V15.89Screening Pap smearOnce every 2 years; once every year for high-risk patients*Q0091V76.2, V76.47, V76.49 or V15.89Digital rectal examOnce every 12 months for patients 50 years or olderG0102V76.44PSAOnce every 12 monthsG0103V76.44Fecal occult blood testOnce every 12 monthsG0107V76.41G0328V76.51

So when you provide a comprehensive history and examination as described by the preventive medicine services codes to a Medicare patient, you should submit the appropriate HCPCS and ICD-9 codes to Medicare for the covered screening services and assign the appropriate CPT preventive medicine services code to the rest of the visit, charging the patient for that portion. These codes can be reported for the same visit because the Medicare-covered screening services don’t include all the work normally included in a preventive medicine visit. For example, HCPCS code G0101 only includes a breast and pelvic examination; it does not include other elements normally included in a preventive exam, such as taking vital signs, examining the skin, heart, lungs, etc., and performing a review of systems or past family and social history. Since the screening services do overlap with some of the preventive services though, the amount allowed by Medicare for the screening should be deducted from the amount billed to the patient for the other preventive services. (See the examples of preventive services for Medicare patients and “Medicare’s covered preventive services” for a list of covered services.)

If you can hear a strange noise coming from your wheels – it could be an issue with your wheel bearings. It could also indicate a serious issue.

It’s worth noting that the specific location and design of bearings may vary slightly between different vehicle models and manufacturers. It is recommended to consult the vehicle’s manual or visit a trusted local garage for an accurate assessment and information regarding your specific car’s wheel bearing location – and what is needed to fix it.

To ensure that you’ll receive at least some reimbursement, you can try reporting either the preventive medicine or the problem-oriented service, depending on which of the two services was the primary focus of the visit and required the most significant amount of physician time and work. Or you could have the patient return for another visit to address the management of the problem or the preventive care. Deciding which of these options to choose depends on the clinical circumstances and your medical judgment. In either case, any diagnostic tests or additional services provided should be reported separately.

A 52-year-old established patient presents for an annual exam. When you ask about his current complaints, he mentions that he has had mild chest pain and a productive cough over the past week and that the pain is worse on deep inspiration. You take additional history related to his symptoms, perform a detailed respiratory and CV exam, and order an electrocardiogram and chest X-ray. You make a diagnosis of acute bronchitis with chest pain and prescribe medication and bed rest along with instructions to stop smoking. You document both the problem-oriented and the preventive components of the encounter in detail. You should submit 99396, “Periodic comprehensive preventive medicine ..., established patient; 40-64 years” and ICD-9 code V70.0, “Routine general medical examination at a health care facility”; and the problem-oriented code that describes the additional work associated with the evaluation of the respiratory complaints with modifier -25 attached, ICD-9 codes 466.0, “Acute bronchitis” and 786.50, “Chest pain” and the appropriate codes for the electrocardiogram and chest X-ray.

Improper installation: If a wheel bearing is not installed correctly during maintenance or repair, it can lead to premature wear and noise. Improper installation can result in misalignment or insufficient torque, causing the bearing to wear unevenly.

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It's advisable to check with local automotive parts suppliers or contact a trusted local garage to get more accurate pricing information specific to your vehicle.

The bearing is typically mounted within a hub assembly or wheel hub, which connects the wheel to the vehicle's suspension system.

Appropriate ICD-9 codes should be reported on every claim to provide an accurate reflection of the reason a service was provided. It’s also important to link each ICD-9 code to the applicable CPT code on the claim form, especially when preventive and problem-oriented services are provided at the same visit. The ICD-9 codes associated with preventive services are found in the V codes, which describe the reasons for health care encounters other than disease or injury. For example, V70.0 should be used for a routine general medical examination performed at a health care facility, and V70.3 should be used to identify examinations for administrative purposes, such as marriage and school admission. Other V codes commonly used for preventive services include V72.3 for reporting a gynecological examination performed in conjunction with a preventive service, V20.2 for a routine infant or child health check and V73.0-V82.9 for any special screening examinations (e.g., for colorectal cancer or lipid disorders).

This article explains how to properly code and bill for the standard preventive evaluation and management (E/M) visit, the preventive E/M visit with a problem-oriented service, the preventive visit for a Medicare patient and the preventive counseling visit.

A car wheel bearing is a crucial component of a vehicle's wheel assembly that enables smooth and efficient rotation of the wheel while driving.

If you suspect a faulty wheel bearing, it is essential to have it inspected and repaired by a qualified mechanic. Ignoring a worn or damaged wheel bearing can result in further damage to the wheel assembly and compromise the safety and performance of your vehicle. Alternatively, take your vehicle to your local garage to get the problem resolved.

If a wheel bearing is damaged or worn, it should be replaced promptly to ensure safe operation of the vehicle and prevent further damage to other components.

An established Medicare patient presents for management of hypertension and preventive services. Medicare covers the full allowable amount for all reported services. You should submit the following codes and related charges to Medicare: G0101 for the pelvic exam and clinical breast check, Q0091 for the collection of the Pap smear specimen and V76.2; and 99213 for the established-patient office visit (with modifier -25 attached) and 401.1, “Essential hypertension, benign.” The total amount billed for this visit should be $127.30.

As described above, age-appropriate counseling that occurs during a preventive medicine encounter is part of the preventive medicine services codes, but preventive counseling and/or risk factor reduction interventions that are provided at a separate encounter should be reported with the preventive counseling codes. This type of counseling varies according to the age of the patient, but it generally includes such issues as diet, exercise, smoking cessation and sexual practices. Note that counseling provided to patients with diagnosed conditions or signs and symptoms should be reported with the problem-oriented E/M service codes instead. (See the example of a preventive counseling visit.)

When a patient comes into the office for a routine preventive examination and also has significant new complaints (e.g., chest pain or irregular bleeding) and, in some instances, a new or established chronic condition (e.g., hypertension or type-II diabetes), the visit becomes a combination of preventive and problem-oriented care. As long as service is clearly documented and distinct from the documentation of the preventive service, CPT suggests submitting a preventive medicine services code (99381-99397) for the routine exam and the appropriate office visit code (99201-99215) with modifier -25, “Significant, separately identifiable [E/M] service by the same physician on the same day of the procedure or other service,” attached to the problem-oriented service. It’s also especially important to link the appropriate ICD-9 code to the applicable CPT code in these cases to help distinguish between preventive and problem-oriented services. (See the example of a preventive E/M visit with a problem-oriented service, and for more on ICD-9 codes, see “Using diagnostic codes effectively.”)

Depending on the vehicle’s design, there may be one or two wheel bearings per wheel. In a front-wheel-drive vehicle, each front wheel usually has a wheel bearing assembly, while rear-wheel-drive vehicles may have wheel bearings in the front and rear wheels.

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The comprehensive history and examination performed during a preventive medicine encounter are not the same as the comprehensive history and exam that are required for certain problem-oriented E/M codes (99201-99350) and defined in Medicare’s Documentation Guidelines for Evaluation & Management Services. In fact, the documentation guidelines don’t apply to preventive medicine services. The history associated with preventive medicine services is not problem-oriented and does not involve a chief complaint or history of present illness. It does include a comprehensive review of systems, a comprehensive or interval past, family and social history, and a comprehensive assessment/history of pertinent risk factors. The preventive-visit examination is multisystem, but the precise content and extent of the exam is based on the patient’s age, gender and identified risk factors.

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Preventive medicine coding varies based on the type of visit – a standard preventive E/M visit, a preventive E/M visit with a problem-oriented service, a preventive visit for a Medicare patient and a preventive counseling visit.Some, but not all, payers will reimburse both preventive and problem-oriented services on the same date.Medicare does not provide reimbursement for CPT’s preventive medicine services codes, but it does cover some screening services.

A 65-year-old established Medicare patient presents for her annual well-woman exam. Medicare covers the collection of a screening Pap smear and her pelvic exam and clinical breast check for that year. You should submit the following codes (and related charges) to Medicare: G0101 for the pelvic exam and clinical breast check, Q0091 for the collection of the Pap smear specimen and V76.2, “Special screening for malignant neoplasms; cervix”; and the following codes (and related charges) to the patient: 99397, “Periodic comprehensive preventive medicine ... established patient, 65 years and over,” and V72.3, “Special investigations and examinations; gynecological examination.” The total amount billed and received for this visit should equal your usual charge for an annual exam of $100. BillDiagnosis code(s)Procedure code(s)ChargeMedicareV76.2Special screening for malignant neoplasms; cervixG0101Pelvic exam and clinical breast check$36.60Q0091Collection of Pap smear specimen$37.70PatientV72.3Gynecological examination99397Preventive service$25.70Total amount billed and received$100.00 An established Medicare patient presents for management of hypertension and preventive services. Medicare covers the full allowable amount for all reported services. You should submit the following codes and related charges to Medicare: G0101 for the pelvic exam and clinical breast check, Q0091 for the collection of the Pap smear specimen and V76.2; and 99213 for the established-patient office visit (with modifier -25 attached) and 401.1, “Essential hypertension, benign.” The total amount billed for this visit should be $127.30. BillDiagnosis code(s)Procedure code(s)ChargeMedicareV76.2Special screening for malignant neoplasms; cervixG0101Pelvic exam and clinical breast check$36.60Q0091Collection of Pap smear specimen$37.70401.1Hypertension, benign99213-25*Office visit$53.00Total amount billed and received$127.30

Medicare does not provide reimbursement for CPT’s preventive medicine services codes, but it does cover some screening services.

It's crucial to note that these are general guidelines, and the specific steps and procedures can vary depending on your vehicle's make and model.

Age-appropriate counseling and discussion of issues common to the age group are also included in the preventive medicine services. For example, issues related to contraception are discussed with women of child-bearing age, and anticipatory guidance is given to parents of pediatric patients. Review of safety issues, the need for screening tests and discussions about the status of previously diagnosed stable conditions are also considered part of the comprehensive preventive medicine service.

In most vehicles, the wheel bearing is a sealed unit that is pressed into the hub assembly. It is positioned between the inner and outer bearing races, which are the metal rings that contain the steel balls or rollers.

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