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#1
05-23-2009, 12:38 PM
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Diabetic Patient/Two Doctors
After a comprehensive exam & history with medical decision making of high complexity, Dr. Nitro a family physician admits the patient, Sue Smith, in an uncontrolled diabetic crisis (ketoacidosis). Sue is a Type II diabetic that takes insulin. Dr Nitro quickly realizes that the needs to call in an endocrinologist for advice. Dr Brown sees Ms Smith as a new patient that day. He performs and documents a detailed history & exam with moderated complexity medical decision making. He then suggests to Dr Nitro a change in her medication and some additional tests. Dr Nitro follows through with the suggestions, with no improvement. On the morning of the second hospital day after a problem focused interval history, expanded problem focused exam and low complexity medical decision making. Dr Nitro requests Dr Brown to take over the care of Ms Smith. Dr Brown is able to stabilize the patient after the expanded problem focused exam and medical decision making of moderate complexity. The patient is discharged on the third day with her diabetes under control. The discharge taked 25 minutes.
1. What CPT & ICD9 CM codes should be utilized for Dr Nitro services? 2. What CPT & ICD9 CM codes should be utilized for Dr Brown? 
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#2
05-25-2009, 02:16 PM
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Without the notes
Without seeing the actual notes (and wondering if this is a classroom exercise / test or homework question) ...
Day 1 - Dr Nitro has an initial hospital visit or possibly critical care (if Dr N spent at least 30 minutes providing critical care to a critically ill patient - DKA is usually critically ill). Dr Brown has a consultation (Dr N asked for his advice) - doesn't make any difference if patient is new or established. Day 2 - they each have a subsequent visit (although you may only get paid for one of them) Day 3 - Dr Brown has a discharge F Tessa Bartels, CPC, CEMC
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#3
05-26-2009, 04:09 PM
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Thanks for the info...this is a classroom exercise that I have and just wanted anyone else's opinion on this..... I kinda was having a hard time with it
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#4
05-30-2009, 01:06 PM
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Any other suggestions or comments on the way I coded this?
Dr Nitro.....
Day 1 99223 250.12 V58.67 Day 2 99231 250.12 V58.67 Day 3 ------ ------ ------- Dr Brown Day 1 99243 250.12 V58.67 Day 2 99232 250.12 V58.67 Day 3 99238 250.00 V58.67 Please let me know what you think and offer any suggestions... Last edited by RSnodgrass; 05-31-2009 at 01:10 PM.
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