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  1. MikeEnos

    Help with HPI points for new patient

    The phrase "here to establish care" tells you that this is an annual preventive exam, not a "sick visit." There is no sufficient chief complaint or HPI to support a sick visit.
  2. MikeEnos

    CPMA CEUs: how do I get them?

    I signed up for the yearly webinar subscription from AAPC. The good news is they have a wealth of webinars that will get you your CEU's in no time, and they're great material. The bad news is that I keep adding them to my CEU tracker, and for some reason they are counting towards my CPC but...
  3. MikeEnos

    MDM - Manangement option

    Yes, I use the list tony provided. His link didn't work for me, try this one If that doesn't work, this will. Just do a Google search, it's the first result.
  4. MikeEnos

    HPI Question

    This same question was asked a few weeks ago. In fact, the same example (cough) was used. My answer even includes a mental disorder being located in the brain. Here, I'll copy and paste it for you:
  5. MikeEnos

    Rx Drug Management

    Prescribing a new medication absolutely counts as prescription drug management, along with the other things you mentioned (increasing/decreasing dosages, refilling or stopping a prescription.) Think about it. The provider doesn't just write down a prescription without giving thought to the...
  6. MikeEnos

    Exam

    I agree with Tony. I don't see how anyone could differ, CMS is unambiguous on this. According to CMS: So yes, as long as they aren't seeing the doctor for a problem with their Eyes, Earns, Nose, or Throat, you can give credit for the statement HEENT: normal as review of the Head, Eyes, and...
  7. MikeEnos

    E&M Level for Orthopaedic Est Pt

    Regardless of whether you feel the Medical Decision Making was Low or Moderate, you don't qualify for a L4 new patient visit, because you don't have a comprehensive history. For an established patient, you would qualify as L4 because you have at least a detailed history and exam, so depending...
  8. MikeEnos

    New patient

    According to CMS: So yes, assuming they have documented the total length of the encounter, that greater than half of it was spent counseling, and the content of the counseling, they can bill the E/M visit based on the time. It doesn't matter what level of history, exam, or medical decision...
  9. MikeEnos

    chart note abstracting

    The contractors I've asked have not accepted 'inferred' location. Meaning you can't just infer that the location of depression is the brain, or the location of asthma is the lungs, or hypertension is the heart, etc. For some problems you can get a location (left knee or right thumb) but some...
  10. MikeEnos

    What level?!? ASAP

    Well no, it isn't a 99204. You don't have a complete review of systems, means you can't have a comprehensive history. The blurb at the bottom about time doesn't cut it, either. It's a bit confusing but all it gives us is the total face-to-face time. In order to select the level of service...
  11. MikeEnos

    E&M auditing tools

    When I'm training providers on E/M, I usually show them the requirements of the common codes they will use, then walk them through an audit tool. Here's a free one. And here's an E/M pocket reference I made.
  12. MikeEnos

    Use of an interpreter

    You would have to check with your local carrier. Some do not give any complexity, believing that a translation is more of a tool being used and doesn't add complexity. Others (rightly, in my opinion) factor in that use of a translator does add complexity and time to the encounter, as the...
  13. MikeEnos

    Comprehensive HX for a Newborn 99222

    Regarding Medical Decision Making, you can pretty much just use the same tools (Marshfield Clinic) we use for adults. Granted, you should keep in mind the complexity and risk that the provider is dealing with since it is a newborn who requires admission, but I don't think there are any...
  14. MikeEnos

    e/m levels for non verbal

    Agreed. If the provider documented the length of the encounter, and how he counselled the parents/caregivers.... or documented getting history from someone other than the patient... or even documenting what review of systems he can ascertain, then stating that the rest of the ROS was...
  15. MikeEnos

    Thank you, and 2 free E/M coding references

    Hi everyone, I just wanted to say thanks to all of you who participated in the beta test and helped by giving me your feedback. I really appreciate your hard work! The beta test is now completed, so I just wanted to let you know that I don't need any more volunteers at this time. To give...
  16. MikeEnos

    Hpi/ros

    If I'm understanding what you're saying, then that is a complete ROS. If the HPI states positive and pertinent negative ROS findings, and the ROS states "as in the HPI, all other systems are negative" then that satisfies the criteria for a complete ROS as per CMS. Now, if they routinely...
  17. MikeEnos

    Evaluation and Management eLearning Course - Beta Testers Needed!

    Evaluation and Management eLearning Course - Beta Testers Needed! [UPDATED - FULL] UPDATE: Wow, thanks so much for the great response. I had hoped there would be some willing beta testers but I was overwhelmed by the amount of requests! I'm going to temporarily put a halt on beta testers, I...
  18. MikeEnos

    H&P Family History

    I have seen that phrase too, and I didn't give credit. I was told that some EMR's will automatically insert that phrase in an attempt to prompt the provider to document some family history. Stating that there is nothing on file is not enough to get credit for documenting family history.
  19. MikeEnos

    E/M cheat sheet - I'm hoping someone

    Folks, NOBODY IS EMAILING ANYTHING TO ANYBODY This thread is over 4 years old. Putting your email address in a public forum may cause you to receive spam, junk mail, phishing emails, or viruses. I strongly recommend you not respond to threads like this just asking for copies of things. If...
  20. MikeEnos

    99203 or 99204

    Well, a 99204 requires a Comprehensive exam. Since you only have three systems there I would say you would be VERY generous to even call this a 99203. I would lean more towards calling that exam expanded problem focused, limiting this to a 99202.
  21. MikeEnos

    Texting an MD to ask a question....

    I'm all for the providers getting together and reviewing the guidelines to compare notes and see if they can code for higher levels of service. In my experience most of the coding errors I come across are undercoding. That said, I was just at a regional MGMA conference in Newport and there are...
  22. MikeEnos

    Billing with Medical students dictation??

    Here is what Medicare says in the Medicare Claims Processing Manual Chapter 12 Section 100.1.1 Paragraph B Emphasis mine. I hope that helps answer that question.
  23. MikeEnos

    Texting an MD to ask a question....

    Texting the MD with PHI would be a HIPAA violation, so I would recommend stopping that practice right away. You also can't use the time spent texting between the NP and MD as total time for the length of the encounter. Counseling also has to be face-to-face so it can't count towards the...
  24. MikeEnos

    MDM and CMS HELP

    Your doctors are right. Medical Decision Making IS NOT the same as medical necessity. CMS does not require it to be 1 of the key components used to determine the level of service for an established patient. Generally speaking it is a good indicator of the level of service. Generally speaking...
  25. MikeEnos

    New Patient Office Review

    I honestly can't figure out what your scoring methodology means. When you say ROS = 5, does that mean 5 systems?? I'm getting different figures. ______________________________________ Level of History: HPI - This is borderline, I see enough to call it extended but others may call it brief...
  26. MikeEnos

    Free Coding Resources!

    Thanks for the update, R.Whiting. In the future, giving details is always a good idea. I wouldn't advise people to click on links with vague titles like Great deals! Amazing secret Opportunity of a Lifetime!
  27. MikeEnos

    Can I bill E&M if pt was not in office??

    Hi Rachel, this exact question was asked this forum last month. Here's my response: You might think the answer is yes, but it's not. Yes - the CPT guidelines say that time may be considered when counseling or coordination of care dominates the encounter. Yes - The counseling can be with the...
  28. MikeEnos

    prescribing antibiotics

    Yes, prescribing any prescription drug is prescription drug management.
  29. MikeEnos

    Subsequent Hospital code after a discharge code

    My advice would be not to bill the discharge, since they weren't discharged. That way Dr. B can still bill for his inpatient follow-up. Depending on the work Dr. A did, perhaps his encounter can be billed as an inpatient follow-up as well.
  30. MikeEnos

    PATH attestation

    I'm a little confused by the question, all entries in the medical record should be dated. Attestations included. If it is an EMR entry, that is usually automatic. The attestation should be for the day they personally saw and examined the patient, so it should match up with a resident's note...
  31. MikeEnos

    Physical Exam - Question on the physical exam part of documentation

    You are allowed to mix and match body areas and/or organ systems for an Expanded Problem Focused or Detailed exam, but to get a Comprehensive exam using the '95 Guidelines you must have findings of organ systems only. Body areas don't count. I'm not exactly sure why. Keep in mind that just...
  32. MikeEnos

    PATH attestation

    The physician must indicate that they were present for the critical or key part of the service, and any involvement they had with the plan of care. The statement you quoted does seem to get that across. Here's the relevant excerpt from the Medicare Claims Processing Manual Chapter 12 Section...
  33. MikeEnos

    face to face?

    You must know that the CPT definitions for E/M services are not very specific, so most insurances defer to CMS when calculating level of history, exam, medical decision making, and other E/M nuances that are not well-defined by CPT. I'm sure you could think of 100 scenarios, as could I, but I'm...
  34. MikeEnos

    Does 99214 = 99204 or 99205?

    Either you didn't understand them, or they don't know what they are talking about. Jen spelled out all the possibilities above, but there is no scenario where a 99214 (which is a detailed history and exam, with moderate MDM complexity) would cross-walk to a 99205 (which is a comprehensive...
  35. MikeEnos

    Urgent Care E/M

    non-face-to-face services would not count, so they would still be new patients.
  36. MikeEnos

    Coder Wanted: Pediatric E/M Coder (remote)

    This isn't really the forum for these type of requests. There is an Employment forum, and a job database that can help narrow down your search. Good Luck!
  37. MikeEnos

    Urgent Care E/M

    Isn't Urgent Care a different specialty? Is it recognized as being different from primary care and pediatrics? If not, then you are correct - it would be an established patient since the patient was seen by another provider of the same group and specialty within the last 3 years.
  38. MikeEnos

    face to face?

    I would imagine so, the only alternatives would be to bill a fetus or not bill at all. Seems like legitimate medically necessary counseling.
  39. MikeEnos

    face to face?

    Yes - the guidelines say that time may be considered when counseling or coordination of care dominates the encounter. Yes - The counseling can be with the patient and/or the family - but I believe the family counseling must still be done in the context of a patient encounter. For example, you...
  40. MikeEnos

    face to face?

    Was this family psychotherapy without the patient present? (90846) OR was this a biopsychosocial assessment/intervention? For example- Health and Behavior intervention, each 15 minutes, face-to-face w/ family (without the patient present) (96155) You can't bill a typical office visit...
  41. MikeEnos

    Help with HPI scoring

    I would advise against cross-posting the same question in different forums. Reviewing this, you seem to have a brief HPI. The History overall appears to be Expanded Problem Focused. ROS wasn't separately listed but they did review depression. The exam appears to be Expanded Problem Focused...
  42. MikeEnos

    Help with scoring HPI

    I would advise against cross-posting the same question in different forums. Reviewing this, you seem to have a brief HPI. The History overall appears to be Expanded Problem Focused. ROS wasn't separately listed but they did review depression. The exam appears to be Expanded Problem Focused...
  43. MikeEnos

    E/M time coding question

    Yes, Ariel - Meagan is right. It's the total time. Just make sure the note clearly states: A) The total length of the encounter (read the E/M guidelines because there is a difference between inpatient and outpatient.) B) Greater than half of the time was spent in counseling and/or...
  44. MikeEnos

    Adequate Family History?

    Interesting, I usually count "No sick contacts" as social history. I figure Medical history is illnesses, surgeries, medications etc that this patient has or has had in the past. Family history includes diseases or illnesses that could be hereditary that might contribute to the patient's...
  45. MikeEnos

    Physical Examination document requirements

    I'm a little confused so I'll give advice on 2 possibilities: 1) If the physical exam literally states "The exam was completely normal" or "A comprehensive exam was within normal limits" that is not sufficient documentation to get credit for a comprehensive exam. You are allowed to list...
  46. MikeEnos

    ROS for dermatology. Please help

    Yes, you can count negative findings on the ROS. I get a Comprehensive history from what is documented. Extended HPI Complete ROS All 3 elements of PFSH
  47. MikeEnos

    E/M services using the 95 guidelines vs 97 guidelines

    I don't understand the question. Are you asking which you should use? What specialty?
  48. MikeEnos

    Valid HPI?

    I would say it is brief, but it is valid HPI. Assuming normal findings the V code for personal history of skin cancer may explain the medical necessity for today's visit.
  49. MikeEnos

    General radiology coding question

    Can anyone enlighten me regarding the average number of cases or charts a radiology coder might be expected to code per hour or per day? Any help would be appreciated. Thanks.
  50. MikeEnos

    Exam for musculoskeletal

    There is some truth to that. You see, cyanosis and edema are cardiovascular findings. Digital clubbing is a musculoskeletal finding. Alternatively, you could count the body areas (Left Upper Extremity, Right Upper Extremity) but you can't count the same finding as both. Either way, you...
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