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Gastroenterology Coding Alert

READER QUESTIONS:

Counseling Must Dominate Exception Claims

Published on Sun Jan 10, 2010

Question: A new patient with a chronic gastric ulcer meets the gastroenterologist for management of her condition. The gastroenterologist meets for 34 minutes with the patient, and performs an expanded problem focused history and exam and straightforward medical decision making. The note also indicates that she spent 21 minutes advising the patient on proper diet and medication management. Is this an instance where I can code based on total encounter time? New Jersey Subscriber Answer: Maybe. Go back and double-check both the total encounter time and the amount of time the spent on counseling by either the physician or any nonphysician practitioner (NPP). If the provider spends at least half (16 min) of the total session time counseling the patient, then report 99203 (Office or other outpatient visit for the evaluation and management of a new patient,  hich requires these 3 key components: a detailed history; a detailed examination; medical [...]
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