E&M w/ testing


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I’m trying to reach out in need of some direction or help understanding how to code a specific procedure which are methods of administration and draws of blood.

Wanted to know if anyone in their practice bills/codes for Leuprolide stimulation testing/Pituitary testing and how they code it, unable to locate any specific guidelines.

I have a provider who sees the child and decides patient should have this particular test, the parent agrees and patient is to come back and have the test done.
When the child comes back to have this test done, the provider is entering the procedure codes that involved doing this test with E/M 99214. I spoke with the provider why entering charges of 99214. Provider stated because they are following up with the patient and this test last about 2-4 hours, provider is trying to get credit for just being in the office and checking in on patient while they wait during each blood drawn.

After review, the E/M is not significant separately identifiable. There is no new symptoms, no new complaints, no new exam from the patient/parent, everything is the same as previous visit, there is nothing prompting a new history, exam or MDM. If I'm correct per E/M guidelines, only qualifies if services rendered are above and beyond the usual care associated with the procedure/test.

I just want to make sure I help the provider get their proper reimbursement but at the same time help explain why E/M 99214 is not appropriate.

Appreciate any resources or help. Thank you!


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You are correct. Especially since the testing was decided upon at the previous visit and the specific reason the patient is there. There was no separately identifiable service.