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Calling all E&M experts need help!!!

Love Coding!

Expert
Messages
372
Location
Laveen, AZ
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Hi out there, I need a guide to show me how I should code this visit.

Established pt comes in for his monthly acne follow up being treated with Accutane. I have a P.A. that I work with that insists that these patients should be coded as a level 4 (99214) every time they are seen. I disagree,
in regards to E & M and medical decision making, I say this should be coded as a 99212, here is my reasoning...

A - Amount of diagnosis or treatment options = 1 established problem stable
B - Level of Risk = moderate for prescription drug mgmt.
C - Amount of data to be reviewed = 1 for labs reviewed

Final result for complexity
A - minimal
B - moderate
C - minimal
___________
99212 - 2 of three meet

Is this correct?

Thank you

dscoder74
 

Lorisvg

Networker
Messages
91
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Depending on the rest of the documentation, that type of visit would be a 99212 or 99213. Not a 99214 for a routine follow up. The complexity portion of the visit that you describe is a 99212.
 

Love Coding!

Expert
Messages
372
Location
Laveen, AZ
Best answers
0
Hello,

The pt meets a Extended HPI (4 elements meet ), Complete PFSH ( Past , family and social meet), Detailed exam (5-7 body areas are looked at). The dosage of medication is the same (Moderate for pres drug mgmt). Routine labs were reviewed at the time of the visit.

So based on this the MDM is the driving factor right?

Number of diagnosis = 1 straightforward
Risk of complications = moderate
Amount of data to be reviewed = 1 straightforward
_________________________________

2 of three need to meet or middle

:0)
 

Jagadish

Guru
Messages
155
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0
Its a level 2 visit. Histoy and PE are detailed but when we are considering a level based on 2/3 components, MDM should be one of them. As MDM is SF for this visit the level is 99212.
 

Jagadish

Guru
Messages
155
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0
Please refer to Letters to Editor section of June 2008 Coding Edge for Dr. Spain's rationale on this.
 

djrumery

Networker
Messages
25
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0
You don't mention ROS in your post, but hx is based off HPI, PFSH AND ROS. So in order to get your history level, you would need all three of those elements. My guess is that your ROS is 1 for integumentary, so based on what you have posted and that assumption on my behalf, I'd say your history is likely expanded. If that is the case, and your exam is detailed as you state and your MDM is straightforward as you state, your level of service would be a 99213.

I am looking at my CPT book and nowhere does that or the 1997 Documentation Guidelines specify that MDM MUST be one of the 2 elements counted in leveling, it merely states "requires at least 2 of these 3 key components".
 

Love Coding!

Expert
Messages
372
Location
Laveen, AZ
Best answers
0
Thank you all for your input, ROS which I did not place into my question, was 2-9 bullets. I have spoken to several coders that agree that MDM is the driving factor for a visit. If your doctor codes a Detailed HPI, Extended ROS, Complete PFSH, and a Detailed Exam and all that was done was destroying a wart and recheck for a rash, why would you code a 99214 based on HX and Exam? No disrepect to anyone just an opinion.

Thanks everyone!!

Have a great weekend!
 
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