Primary Care Coding Alert

Remember, physician presence not always needed for checkup Records show that 87 percent of Medicare beneficiaries reported at least one chronic condition in a 2002 beneficiary survey, so chances are high that you code for chronic conditions regularly. Some of the most common chronic conditions include the following: 250.xx -- Diabetes 272.0 -- Pure hypercholesterolemia 290-319 -- Mental disorders 401.x -- Essential hypertension 428.x -- Heart failure 496 -- Chronic airway obstruction, not elsewhere classified 530.81 -- Esophageal reflux 585.x -- Chronic kidney disease (CKD) 714.0 -- Rheumatoid arthritis 715.xx -- Osteoarthritis and allied disorders 733.0x -- Osteoporosis. Watch Out: Chronic conditions may require frequent checkups that may not always require the physician's presence in the exam room. Example 1: A patient presents for a blood sugar log review for potential medication adjustment for type II uncontrolled diabetes, performed by a nurse in accordance with the patient's plan of care. Solution: Report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, five minutes are spent performing or supervising these services) for the service, says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting in Lansdale, Pa. The diabetes code should be 250.02 (Diabetes mellitus without mention of complication; type II or unspecified type, uncontrolled). Be sure that the documentation shows the medically necessary reason why the practice performed the blood sugar log review. Example 2: A patient presents for a blood pressure (BP) check to assess whether a new medication regimen is working. A registered nurse (RN) takes the patient's BP following the plan of care established by the physician for the patient's hypertension. Solution: For the BP check, again report 99211, Falbo says. For the diagnosis, you-ll need more details for the appropriate code. Depending on your documentation, 401.1 (Essential hypertension; benign) may be appropriate for the hypertension. Important: There is no cheat sheet for coding chronic conditions -- you need to look for them on a case-by-case, visit-by-visit basis, says Suzan Hvizdash, CPC, medical auditor for University of Pittsburgh Physicians in Pennsylvania. For example,‧high blood pressure may be a chronic condition for a patient who then makes some lifestyle changes that bring his blood pressure into the normal range.