Wiki EM levels-Insect bite/stings

[amexnikki23]

I have an EM guideline sheet developed by 'E/M University' that our practice utilizes; it's basically the same as the CMS EM guidelines. In the risk table it gives insect bites as an example of a self-limited or minor problem, yet every provider I audit for (10+ providers) consistently use a 99213 each and every time, and will even use a 99203 on a new patient. I can justify this when maybe inflamed, warm to the touch possibly infected, some labs run for suspected viruses, etc. but in the case of a simple insect bite, no tests run, no signs of infection of imbedded stingers or bug parts, etc., wouldn't this just be a straightforward MDM with minimal risk? Our providers almost NEVER ever code a 99212. Just wondering if what others are seeing out there. Thanks!

 

[stephanie7480]

I have an EM guideline sheet developed by 'E/M University' that our practice utilizes; it's basically the same as the CMS EM guidelines. In the risk table it gives insect bites as an example of a self-limited or minor problem, yet every provider I audit for (10+ providers) consistently use a 99213 each and every time, and will even use a 99203 on a new patient. I can justify this when maybe inflamed, warm to the touch possibly infected, some labs run for suspected viruses, etc. but in the case of a simple insect bite, no tests run, no signs of infection of imbedded stingers or bug parts, etc., wouldn't this just be a straightforward MDM with minimal risk? Our providers almost NEVER ever code a 99212. Just wondering if what others are seeing out there. Thanks!

Based on the documentation you described above. You have my vote and I agree.
New Prob no work up = 1
Nothing reviewed = 0
Table of risk = Minimal

SF MDM

 

[lgardner]

I agree.

I was talking to one of my providers...explaining to him why I had to down-code one of his encounters to a 99212 (it was a similar situation) and he stated "I thought that any time I walk in the room it was an automatic 99213".

we then proceeded to have a discussion of the requirements of an E&M visit.

I still find he needs a reminder about once a year or so.

 

[chasarmil]

I agree for an insect bite, with no issues and nothing prescribed, I would give straightforward medical decision making.
I had one provider that charged a 99214 for an insect bite and the only thing that was said to the patient was he could use ice to reduce the swelling.