Coding for Accutane/Acne patients established

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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
 

lspray

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Hello, We do bill 99214 or 99213. Accutane is a high risk medication (V58.69), we are evaluating the acne and the medication at each visit.
 

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Hi Linda,

I am curious to find out, when you use the E/M evaluation sheet under complexity..

A - Number of diagnosis or treatment options
answer - 1 if the acne is stable and improving and it is documented as such

B - Risk of complications and/or Morbidity or mortality
answer - High - due to drug therapy requiring intensive monitoring for toxicity

C - Amount and/or data to be reviewed
answer - 1 review and/or order of clinical lab tests

Line them up 2 of three or middle and you get 99212. Am I missing something?

Thanks!


dscoder74
 

Lisa Bledsoe

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I agree with dscoder. Although I know many providers who feel that they are providing a level 4 visit because accutane is a high risk med, but if all is stable it really shouldn't be a 99214.
 

Love Coding!

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Accutane followup

I agree with dscoder. Although I know many providers who feel that they are providing a level 4 visit because accutane is a high risk med, but if all is stable it really shouldn't be a 99214.
Hi Lisa,

Thanks for the reassurance!

dscoder74
 

lspray

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Sorry took so long for me to reply. I agree to disagree, especially with Accutane. We do a thorough ROS, PFSH and PHI on the condition and the medication at each visit. If there is a side effect we may end up coding 99214. Generally for the amount of work the physician performs at each visit we bill a 99213 at least.
We order and review labs, prenancy test (if appropriate), rx for accutane (high risk)and continue with contraception, rtn appt documented
 
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99212

Based on the documentation provided (as per dscoder74's first post) I get a 99212.

If your physician(s) document(s) more, lspray, then you could legitimately get level 99213 or 99214.

I agree with dscoder and Lisa Curtis for this case.

F Tessa Bartels, CPC, CPC-E/M
 

dmaec

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I agree with dscoder, Lisa and Tessa too on this one - with the level 2... not much to go on to support anything higher.
{that's my opinion}
 
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