Wiki e/m leveling

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Korbc

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Hey guys!

Since in 2027 i will have to level all OB visits when the guidelines change i was just wondering if you guys would consider this visit a 99212 instead of a 99213. I think it's a 99212

"said patient" is here today for routine OB visit. She complains of itching all over her body. She has a papule rash on arms and legs nothing on abdomen. She said she had itching on lower back as well which there is an open area from her itching. She denies changing any new detergents or soaps. Advised oatmeal bath and benadryl. GBS culture obtained. SOL reviewed. +Fm, -LOF/CTX/VB. Will RTO in 1 week.

thanks!
 
hey guys! also i've seen multiple sources consider pregnancy as a chronic condition when leveling or moderate level in of itself. heres a link to one source

so my question is when someone doesn't have preexisting depression or anxiety but specially pp depression with exacerbation of symptoms and we rx then i would consider that moderate but since it's not preexisting and specifically post partum depression any thoughts on if still moderate level or not for complexity of problems on mdm?

thanks!
 
Korbc said:
Hey guys!

Since in 2027 i will have to level all OB visits when the guidelines change i was just wondering if you guys would consider this visit a 99212 instead of a 99213. I think it's a 99212

"said patient" is here today for routine OB visit. She complains of itching all over her body. She has a papule rash on arms and legs nothing on abdomen. She said she had itching on lower back as well which there is an open area from her itching. She denies changing any new detergents or soaps. Advised oatmeal bath and benadryl. GBS culture obtained. SOL reviewed. +Fm, -LOF/CTX/VB. Will RTO in 1 week.

thanks!
Click to expand...
hmm... I am not an expert but I feel like coding it 99213 because... rash and pregnancy = could fall under Low ( 2+ minor problems) + OTC meds= Low. Low and Low =99213. IF she was not pregnant, then more straight forward 99212. But i am not sure. :)
 
Korbc said:
Hey guys!

Since in 2027 i will have to level all OB visits when the guidelines change i was just wondering if you guys would consider this visit a 99212 instead of a 99213. I think it's a 99212

"said patient" is here today for routine OB visit. She complains of itching all over her body. She has a papule rash on arms and legs nothing on abdomen. She said she had itching on lower back as well which there is an open area from her itching. She denies changing any new detergents or soaps. Advised oatmeal bath and benadryl. GBS culture obtained. SOL reviewed. +Fm, -LOF/CTX/VB. Will RTO in 1 week.

thanks!
Click to expand...
In anticipation of these changes, I would take the time to sit down with your providers and go over the risk table for ob conditions. You can take the one published by the AMA and alter it to suit the types of conditions and situations your provider normally deals with. I did something like this many years ago, but the list in by no means complete. Time to get the providers involved before you may have to bill!
 
Korbc said:
Hey guys!

Since in 2027 i will have to level all OB visits when the guidelines change i was just wondering if you guys would consider this visit a 99212 instead of a 99213. I think it's a 99212

"said patient" is here today for routine OB visit. She complains of itching all over her body. She has a papule rash on arms and legs nothing on abdomen. She said she had itching on lower back as well which there is an open area from her itching. She denies changing any new detergents or soaps. Advised oatmeal bath and benadryl. GBS culture obtained. SOL reviewed. +Fm, -LOF/CTX/VB. Will RTO in 1 week.

thanks!
Click to expand...
You could call it a 3. Low/Min/Low; it would be one of those that if you asked 6 coders you would get 50/50 answers probably. The pregnancy bumps it. Would she have come in for the itching if not for the pregnancy check? Maybe, since she has "open areas from itching". It's 1 chronic + 1minor/self-limited, 1 test, Low risk. Returning in 1 week (quicker follow up than would other wise happen?)

Question 2: It would most likely still be moderate regardless of pre-existing or not because it is exacerbated, but again, everything depends on the documentation of this visit.

Do as @nielynco suggested. Also, I would suggest practicing with leveling them ahead of time so everyone is on the same page. ACOG and others will probably come out with info and resources as it gets closer. Basic E/M understanding and using the webinars and resources already available would help. Don't forget about time also. If a provider wants to code by time they have that option.
Using reputable resources is also a way to go: https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf
www.aafp.org

Coding for Evaluation and Management Services: FAQs

Maximize payment and reduce stress by understanding how to properly document and code for evaluation and management (E/M) services.
www.aafp.org www.aafp.org
 
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