Wiki How do I determine E/M level for prenatal visits for Texas Medicaid

[spope]

Texas requires us to bill "the most appropriate level E/M" for prenatal visits. How do I determine the level of E/M though? Do I use the 3 key components (history, exam and MDM)? My company audits on 1997 guidelines, but with an prenatal visit, there is no "real" physical exam, other than vitals and they take measurements, etc, but no more than 2-3 bullets. And how do I determine the risk for medical decision making? Is it 1 established stable acute problem or I can use the UA, but based on that I would probably never get above a 99212. Anyone have any guidance?

 

[bevlewis07]

Texas requires us to bill "the most appropriate level E/M" for prenatal visits. How do I determine the level of E/M though? Do I use the 3 key components (history, exam and MDM)? My company audits on 1997 guidelines, but with an prenatal visit, there is no "real" physical exam, other than vitals and they take measurements, etc, but no more than 2-3 bullets. And how do I determine the risk for medical decision making? Is it 1 established stable acute problem or I can use the UA, but based on that I would probably never get above a 99212. Anyone have any guidance?

Hello there

AZ medicaid has us using the 99213