Wiki 99205

[despinoza]

If a pt enters an urgent care for Liver pain and possible STD,

pt was dx with:

ICD: UTI (lower urinary tract infection) (599.0)
ICD: Ketonuria (791.6)
ICD: Fatty liver (571.8)
ICD: Abdominal pain (789.00)
ICD: Feared complaint without diagnosis (V65.5)

and the pt has high glucose with ketones. SO the provider advise her to go to the ER for review of abdominal pain and for STD results.

in order to bill 99205, for a new patient both HPI and Exam still have to be comprehensive, right?

PLEASE HELP>>> Provider insists on billing 99205, but documentation only supports E/M 99202

 

[AmandaBriggs]

Per CPT guidelines, a 99205 requires a comprehensive history, a comprehensive examination and medical decision making of high complexity. All of these components must be met to bill this level. The physician could also bill a 99205 using time as long as the physician is careful to document the total time spent face-to-face with the patient, that more than half of that time was spent in counseling and coordination of care as well as a clear description of the content of the counseling and coordination of care. These guidelines can all be found in the E/M section of CPT.