Wiki Biceps reconstruction

Create Wiki
Colliemom

Colliemom

Expert
Messages
408
Location
East Haven, Connecticut
Best answers
0
Patient is seen in follow-up, for a left distal biceps reconstruction from November 2017. The patient had a chronic rupture of the left distal biceps tendon, still experiencing episodic discomfort. The dx submitted was S46.212D, only. Do you think there should be another/or different dx submitted?


Also, the physician and I are disagreeing on the level to bill for this visit.

So this is an established patient visit

There is a detailed hx and a detailed exam. The area of disagreement is the MDM. The patient has only the one established problem, that is not worsening. There is no data/tests to review. The plan of care is "lifting capacity will be raised to 30 pounds. He should follow up in 3 months time. In the interim he is to continue strengthening."

So to me, this is straightfoward MDM.
Diagnoses: One established problem, not worsening = straightfoward
Amount & complexity of data is minimal/none = straightfoward
Risk presenting problem could be low, but diagnostic procedures ordered and management options would only be minimal = straightfoward

The physician feels that this visit is definitely not a 99212. He thinks it should be a 99213, even though I explained that the MDM is the overarching criteria in choosing your code level. He told me, these problems have orthopaedic levels of complexity that are not fully appreciated by one without an orthopedic background.

I admit, I am new to ortho coding, so I am looking for your opinions. What would you code this visit as?
 
Last edited:
Also, the physician and I are disagreeing on the level to bill for this visit.

So this is an established patient visit

There is a detailed hx and a detailed exam. The area of disagreement is the MDM. The patient has only the one established problem, that is not worsening. There is no data/tests to review. The plan of care is "lifting capacity will be raised to 30 pounds. He should follow up in 3 months time. In the interim he is to continue strengthening."

So to me, this is straightfoward MDM.
Diagnoses: One established problem, not worsening = straightfoward
Amount & complexity of data is minimal/none = straightfoward
Risk presenting problem could be low, but diagnostic procedures ordered and management options would only be minimal = straightfoward

The physician feels that this visit is definitely not a 99212. He thinks it should be a 99213, even though I explained that the MDM is the overarching criteria in choosing your code level. He told me, these problems have orthopaedic levels of complexity that are not fully appreciated by one without an orthopedic background.

I admit, I am new to ortho coding, so I am looking for your opinions. What would you code this visit as?
 
This is not 99212

I got this from a AAPC webinar, but ortho patient's who have had surgery are generally 99213 until the last visit when they are released.

99213.
 
Last edited:
You must log in or register to reply here.
Top