Wiki Compliance Issue

[maureen1]

How do you tell a provider it is wrong to consistently use a 99214 on all patient's with chronic issues (ie DM, HTN, etc and OB patients) whether the patient is compliant or not? Is there a guideline somewhere I can look up and copy to give to her. I just see this as an audit nightmare!! PLEASE HELP!!!!!

 

[MnTwins29]

Try it the other way - show her what is required to code at 99214 and show the physician that her documentation does not meet the requirement and specifically where. I suspect that because the HPI is comprehensive with three or more chronic conditions, there is a leap of faith that this is enough for the 99214. Also, is there more to it? If the patient is non-compliant, is there counseling done with the patient? (Record time as that may meet 99214 - think Rolling Stones - Time is on my side) Is there a change in treatment plans?

Keep in mind the E/M code is there to reflect the WORK done by the physician, not the compliance level of the patient. If the physician truly isn't doing the work because of the patient's actions then yes, you can't use 99214, but that would be because of the documentation and work by the doctor, not because of the patient.

 

[CatchTheWind]

I am not aware that the patient's compliance has anything to do with the level you are coding. (Have I missed something somewhere???)

Coding for 99214 has very specific requirements: The chart must meet two of the following three documentation requirements. (And for 99204, it has to meet all three of three):

1) At least 4 HPI points, 2 ROS points, and 1 PFSH point
2) At least 12 exam points
3) At least 3 points each from any two of these: problems, data, risk level

(If it sounds like I'm speaking gibberish, I would suggest taking an E/M coding seminar! I believe that Medicare offers them free.)

Also, as Lance mentioned, you can bill instead based on time; but only if at least 50% of the visit consisted of counseling.

 

[maddismom]

No, you haven't missed anything.