MikeEnos
Guest
I'm auditing an Emergency Department note that was billed as a 99283
The history is detailed
The exam is detailed
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At this point I already know that the code selection is wrong. If the MDM is Moderate, this is a 99284, if it is low, this is a 99282, and if it is straight-forward then this is a 99281.
Here's where I'm struggling:
Diagnosis is Acute Otitis Media. No labs or data are reviewed. Antibiotics are prescribed.
This qualifies for Moderate risk (Rx drug mgmt), with minimal data, but how many points are assigned for the diagnosis of Otitis Media? Is it 1 point, for a self-limited or minor problem, or is it 3 points for a new problem to the examiner, with no additional workup planned? The decision makes a huge impact on the final code selection:
If you assign it as a self-limited or minor problem, then the overall MDM is Straight-Forward and this qualifies as a 99281
If you assign it as a new problem with no workup planned, then the overall MDM is Moderate, and this qualifies as a 99284. That's a huge difference.
What do you folks think? 99281, or 99284?
The history is detailed
The exam is detailed
----------
At this point I already know that the code selection is wrong. If the MDM is Moderate, this is a 99284, if it is low, this is a 99282, and if it is straight-forward then this is a 99281.
Here's where I'm struggling:
Diagnosis is Acute Otitis Media. No labs or data are reviewed. Antibiotics are prescribed.
This qualifies for Moderate risk (Rx drug mgmt), with minimal data, but how many points are assigned for the diagnosis of Otitis Media? Is it 1 point, for a self-limited or minor problem, or is it 3 points for a new problem to the examiner, with no additional workup planned? The decision makes a huge impact on the final code selection:
If you assign it as a self-limited or minor problem, then the overall MDM is Straight-Forward and this qualifies as a 99281
If you assign it as a new problem with no workup planned, then the overall MDM is Moderate, and this qualifies as a 99284. That's a huge difference.
What do you folks think? 99281, or 99284?