referral

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    Wiki What element level of MDM would a specialist referral fall under 2021 E/M Guidelines?

    Our PCP providers would like to consider a referral to a specialist as a LOW RISK under column 3 of the 2021 E/M table for Risk of Complications and/or Morbidity or Mortality of Patient Management. In comparison to Box A. of the 2020 & earlier E/M table and guidelines, whether a condition was...
    • SLindloff
    • Thread
    • 2021 e/m 2021 e/m risk 2021 guidelines e/m changes mdm risk medical decision making referral referrals
    • Replies: 8
    • Forum: E/M
  2. D

    Wiki Referral Carolina Access - Medicaid NC

    I know standard Medicaid does not require a referral and I understand that Carolina Access does for a specialist. My question is does the referral have to have an authorization number on it? I thought it did and when I called the PCP and asked for one I could feel them stare at me through the...
  3. D

    Wiki 2021 E/M MDM Element #3 - Minimal and Low Risk

    Does anyone have any clarification on the new 2021 E/M Guidelines when it comes to Element #3? I am having trouble being able to choose between minimal risk and low risk for a patient because they do not have specific bullet options in those two categories to pick from. For example, if a...
  4. A

    Wiki First listed diagnosis for surgical evaluation for colon polyp

    Hello, I'm a new CPC-A and I'm trying to understand how to select diagnoses for office visits. Am I selecting the diagnosis based on the reason for the visit? Or for the patient's condition at the time of the visit? I know it can be the first one if a diagnosis is not established, and the second...
    • adinson
    • Thread
    • colon polyp first listed diagnosis new patient referral tubulovillous adenoma
    • Replies: 2
    • Forum: ICD-10
  5. M

    Wiki Paitent seen to request referral.

    An established patient was seen to request a referral for weight loss surgery. A physical exam and ROS were done, but no other issues were discussed, just the referral for weight loss surgery. What diagnosis code should I use for this? Is this even billable?
  6. D

    Wiki Code for referrals

    I code for a Family Practice. Say our physician refers a patient for a routine mammogram (Z12.31), do we include this code on our billing as well just because a referral was issued?
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