Primary Care Coding Alert

Ethically boost assessment visits when you find this documentation You can capture the initial service and ongoing visits for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) if you code based on this coding continuum of care. Diagnosis, maintenance, interval checks and reassessment of ADD/ADHD can be nurse-only, brief, or involved-physician visits. Here's your guide to keep the visit types straight and to avoid overlooking ethically deserved payments for these time-consuming encounters. Code Diagnosis Visit as High-Level When the FP diagnoses a patient with ADD (314.00, Attention deficit disorder; without mention of hyperactivity) or ADHD (314.01, - with hyperactivity), it's a high-level E/M service. "You-re probably going to be at 99215 (Office or other outpatient visit for the evaluation and management of an established patient - physicians typically spend 40 minutes face-to-face with the patient and/or family), based on time," says Richard Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio. Counseling and/or coordination of care must comprise the majority of the face-to-face encounter when you use time as the controlling factor when selecting this high-level of E/M service. Tip: Because counseling is usually a predominant component of ADD/ADHD initial diagnosis sessions, anticipate using time to code these encounters, which usually take an hour. Encourage the physician to document the counseling session's content, the total face-to-face time spent, and the time devoted to counseling/coordinating care related to the ADD/ADHD disorder. Don't Overlook Consultation Codes If a school nurse or teacher asked for the FP's opinion on the child, and the physician sends a report to the requesting source, you can report the visit as a consultation if the physician performs and documents the other requirements of this service. "These codes pay significantly more than a comparable office visit," says Stephen R. Levinson, MD, author of the AMA's Practical E/M: Documentation and Coding Solutions for Quality Health Care. Having documentation that shows a counseling-based session of an hour, the time FPs usually spend on an ADD/ADHD initial assessment session, can add more payment for the first diagnosis session. So if documentation supports a counseling-dominated consultation lasting one hour, you can report 99244 (Office consultation for a new or established patient - physicians typically spend 60 minutes face-to-face with the patient and/or family), which has a time allotment of an hour. The Medicare Physician Fee Schedule pays 99215 a national rate of 3.43 transitional non-facility total relative value units compared to 5.06 RVUs for 99244. Before choosing a consultation code for the visit, make sure you meet the service's requirements. Report Mid-Level for Return Visits After a patient has been diagnosed with ADD/ADHD, he's going to have interval brief visits on a scheduled basis with an FP or nonphysician [...]