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EMcoder13

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I have a pediatric provider in our practice that will charge a 99215 for just about every ADD or ADHD med rechecks for children under 18 years old. Face-to-Face time: 10-15 minutes. These patients come in at least 4 times a year or more. (The other providers usually charge a 99213).

Does anyone know what is pertinant for the Review of Systems and Exam for an ADHD patient that is doing good or improving. He does a complete history, complete ROS and complete Exam of every organ system every time the patient comes in.

I have tried to do some research on the internet and coding books, but can't come up with any guidelines. Some articles state that if it is a medication refill it should be 90862 (medication management) and some state the exam should only include constituitional for weight gain/loss, neurologic, and psychiatric.

Any comments or documentation supporting this either way would be appreciated.
 
I still maintain that if the physician documents suffiently for a 99215 then that is the level we apply. It is not up to a coder to second guess what a physician should review or not review for a given visit. Follow the 95/97 guidelines and arrive at a visit level from the documentation, no more that what is there and no less. If you post a sample of one of his visits perhaps we could evaluate and tell you what our assessment is.
 
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