Wiki E/M Coding Help

[WHAUN]

Question 1: A patient has some diffuse AKs that my provider is noting as a chronic illness with exacerbation, progression, or side effects of treatment and she is prescribing 5FU cream. This patient also has (newer, non-diffuse) AKs elsewhere on the body that are not exacerbated/progressed like the other spots and she treated these with liquid nitrogen. Can she call these AKs an acute, uncomplicated illness or injury for a 99214 E/M? Basically, my question is can we use the chronic illness w/ exacerbation/progression AND the acute illness for the same AK diagnosis?

Question 2: Can we count a prescription for cosmetic purposes toward the E/M level? Patient was seen for medical visit but also discussed cosmetic wrinkles at the appointment. She wanted a tretinoin Rx for her wrinkles. I know they went over the rx details with her but it this considered prescription drug management and can count toward E/M?

Any help is appreciated!!

 

[JDACPC]

Q1: You already have chronic illness w/exacerbation/progression, no need to worry about an acute illness. AK is one or the other and I would go with chronic illness since it needs to be monitored for cancer. Add Rx mgt = 99214

Q2: Yes and yes. Management includes the starting of a new Rx.

 

[WHAUN]

Awesome! Thank you for your input! We were looking at it as insurance might think it's fishy billing a 99214 AND liquid nitrogen for one diagnosis of AKs. I suppose this is where documentation is key - documenting why we are prescribing Rx for one area of AKs and only doing liquid nitrogen for another area of AKs.