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level

  1. ksrodgers

    Wiki Level 2 or 3?

    I'm having an impossible time leveling this visit. A patient comes in to request discussion for vasectomy at a PCP visit. The PCP puts in a referral for vasectomy. That is all the note states. The provider does not do an evaluation or give a summary of his discussion (if he had one) with the...
  2. C

    Wiki Reducing the Level of Service / E&M

    Hello. I would appreciate hearing others thoughts on the following issue please. Is there one correct answer? Scenario: CPT 99214 billed. Carrier requests records for a pre-payment review. OV notes are submitted. Carrier reviewed the records and denied the E&M as level of service not...
    • cling2me2
    • Thread
    • downcoding e&m level
    • Replies: 4
    • Forum: E/M
  3. V

    Wiki Medical Decision Making Table (Number of DXs or Treatment options, DATA Reviewed, and Risk table) Examples for Inpatient Hospital Coding 99221-99239?

    Hi, I wanted to ask if someone can provide me with some links or websites or anything really, that may have a list of common illnesses/injuries that are good examples to use for the different levels of the MDM table for Inpatient Hospital Coding (99221-99239) For example, just like on the Risk...
  4. KStaten

    Wiki E/M for Biceps Rupture

    Greetings Fellow Coders :) Since the E/M level is now based upon MDM only, I have been noticing that providers are still in the habit of billing with the old guidelines in mind, which in some cases, would result in higher levels of E/M. I would really appreciate if others can help me out by...
    • KStaten
    • Thread
    • 2021 e/m level level 2 mdm outpatient
    • Replies: 2
    • Forum: E/M
  5. S

    Wiki level of risk

    Could I get some opinions please? Note says: Surgical procedure for resection of plantar calcaneal spur is explained to her in detail.* Surgery is not recommended as of yet. Does anyone else think that the "surgery is NOT recommended" part cancels out the Moderate level of risk that would be...
    • solocoder
    • Thread
    • level moderate recommended risk surgery
    • Replies: 1
    • Forum: E/M
  6. T

    Wiki Modifier U2

    Can someone explain the purpose of the modifier U2 on cpt 59514. When I look it up it only says Medicaid level 2, I want to understand so I will know to code with them or not.
    • TishCpc
    • Thread
    • code level modifier purpose understand
    • Replies: 1
    • Forum: Modifiers
  7. T

    Wiki Question on Level of Service

    For an established patient if the MDM is straight forward does that automatically make the level of E&M a 99212 whether or not you have met the History & Exam? If so can someone please refer me to the guidelines for this to back that up? I was marked off for coding a 99213 where I currently...
    • TMB1965
    • Thread
    • eliminated guidelines level marked refer
    • Replies: 6
    • Forum: E/M
  8. K

    Wiki Level 5 E&M with Oral Challenge

    Good Afternoon, I am looking for confirmation of my assumption regarding this scenario more than I am an answer to the question. Is it appropriate to bill a level 5 E&M in addition to the code for an Oral Challenge if the patient does not require physician intervention for anaphylaxis or...
    • kbmcmahan
    • Thread
    • code e&m level physician procedure
    • Replies: 0
    • Forum: E/M
  9. B

    Wiki laminectomy & PLIF

    can you code BOTH a 22630 & 63047 on same level & get paid?
  10. B

    Wiki Blood Pressure Check - Level 1 Office Visit

    For patient that would come in per a providers order for a blood pressure check, we charge a level one office visit. The nurse input notes in the EHR system with the reading. Now I am told we are not longer going to bill for this service. The nurses are still going to input notes into the EHR...
  11. D

    Wiki Resource

    I still get confused sometimes when trying to determine level of service for an E/M. Is there a good resource book out there that helps in explaining/clarifying E&M coding? Determining the # of diagnosis, level of MDM is so confusing sometimes, it would be helpful to have a good resource that...
    • dixiep
    • Thread
    • confusing diagnosis level mdm resource
    • Replies: 2
    • Forum: E/M
  12. L

    Wiki office visit and consult code

    We had a patient come in for a office visit for constipation. during that visit the provider also did a pre op exam. Can you bill for both the E/M level and a consult code for the Pre-Op? or would you just use a E/M level?
  13. P

    Wiki Question on ED Facility Level Guidelines - Need Clarifiication - LEVEL 4 or 5

    Working for multiple facilities, every one has their own guide on the facility leveling. A question brought up on whether to charge a level 4 or 5. According to the Level 4 intervention guidelines, preparation for 2 diagnostic tests which would include EKG, LABS or XRAY. Special Imaging such as...
  14. Z

    Wiki Is Flat Rate Charging Acceptable?

    Hello, Is a provider allowed to bill the same dollar amount for his office visits? I believe it is reference as "flat rate" billing. Codes 99201-99215 all bill at same amount regardless if have insurance or self pay. Any restrictions with state, federal laws, Medicare, etc.? Note: the...
  15. K

    Wiki New to Chrio Coding

    Hi there, I am new to chiropractic coding. I understand that if it is an established patient you can not code an E/M level and a manipulation on the same day if it is the same diagnosis as before. My question is the Chiropractor I code for almost every time has an office level visit and a...
    • kmccard
    • Thread
    • code diagnosis e/m level manipulation
    • Replies: 1
    • Forum: Chiropractic
  16. S

    Wiki 2016 PQRS for Nursing Home providers

    What measures would you suggest for providers who only see patients in a nursing home setting. These can be mid level or physician providers. Thanks, Sue B
  17. kfrycpc

    Wiki Determining A Consult Level

    Hi all, I'm a little confused when it comes to determine the level for a consult and also for inpatient. For a consult, I know 3 of 3 have to be met. If you have a C History , C Exam and H MDM, what would the level be? For an inpatient, I know 3 of 3 must be met. But if they are not, and say...
  18. R

    Wiki billing E/M level instead of injection

    I have a Dr. who has a question about billing just for his E/M level vist and not for the injection that he gave the patient due to it probabaly being denied. Is this kosher. I am under the impression that you cannot just do this? Any feed back would be appreciated.
  19. C

    Wiki Billing an annaul & E/M at the same time.

    It is my understanding that the annual exam needs a complete past, family & social history. pt. also has a level 4 (99214) illness, how do you separate the history for the annual and the E/M code?
  20. T

    Wiki E/m level 99221 - 99223 and 99231-99223 initial and subsequent hospital care

    Please help, can we as the hospital charge a e/m level for inpatient for a doc either employed or not by the hospital, even if the doc charges a e/m level through their clinic. We are having a discussion on this issue and of course we all do not agree and need outside advice. Or do you know...
    • teresa
    • Thread
    • doc e/m hospital issue level
    • Replies: 1
    • Forum: E/M
  21. C

    Wiki Out patient hospital coding assistance

    If a patient is seen by the provider as an op in bed, due to vomiting in pregnancy can we bill an e&m visit from the 99212-99214 level... She is getting treated with us for her ob. Im confused as it does not state inpatient or observation status.
    • CODING1234
    • Thread
    • inpatient level observation patient treated
    • Replies: 1
    • Forum: E/M
  22. P

    Wiki stent rremoval

    Patient comes in for stent removal 52310. Stone analysis and prevention is discussed. Ultrasound is scheduled in two weeks to ensure no residual. Does this warrant a level 2 EM?
    • phamilton
    • Thread
    • ensure level residual stent weeks
    • Replies: 1
    • Forum: Urology
  23. A

    Wiki Debate

    Question - There has been some debate on two items relating to E/M coding and I would love feedback that may help me to not only educate myself but my physicians and colleagues... 1. Medical Decision Making - we utilize the 1999 Table of Risk - but there is some debate in determining what...
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