rhotonscott
Networker
I am a psych coder but auditing E/M service so this would apply to other disciplines as well:
If a prescriber has a patient with worsening Major depression and delusional disorder with prescription med management, it is a level 4 MDM. At next visit the patient demonstrates as psychotic, going off the deep end in paranoia. The diagnosis changes to a single diagnosis F33.3 Major Depressive disorder, recurrent, severe with psychotic symptoms; even if worsening, our EHR only assigns 2 points for a level 3 MDM. I assign 2 points for worsening depression and allow at least another point for the psychosis, assuming in the least case scenario it is transitory, minor problem- this allows for the level 4 MDM as before. This all assumes that there is sufficient History and/or Exam to back up the level 4 MDM and to code a 99214 in both encounters. Anyone's thoughts on this?
If a prescriber has a patient with worsening Major depression and delusional disorder with prescription med management, it is a level 4 MDM. At next visit the patient demonstrates as psychotic, going off the deep end in paranoia. The diagnosis changes to a single diagnosis F33.3 Major Depressive disorder, recurrent, severe with psychotic symptoms; even if worsening, our EHR only assigns 2 points for a level 3 MDM. I assign 2 points for worsening depression and allow at least another point for the psychosis, assuming in the least case scenario it is transitory, minor problem- this allows for the level 4 MDM as before. This all assumes that there is sufficient History and/or Exam to back up the level 4 MDM and to code a 99214 in both encounters. Anyone's thoughts on this?