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Kittykat1

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If a doctor makes a decision for a 90-day global surgery--carpal tunnel release-- Can he bill 99215? Can someone share their thoughts
 
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Why do you think he can bill a 99215? The level is dependent on the MDM (or time) and requires 2/3 criteria of # of diagnoses, data, risk to meet a certain level. You have only provided the level of risk - decision for a surgery with a 90-day global (which, unless the provider stated the patient was high risk and gave reasons why) would be moderate risk and level 4. What data is there and what are the # of diagnoses in order to accurately code the encounter?
Very unlikely to be a level 5 for carpal tunnel syndrome. Please provide the additional information so we can help you.
 
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He states that the diagnosis of carpal tunnel is a "chronic illness with severe exacerbation, progression or treatment side effects". I informed him that this column was for serious, life threatening issues but he still feels it's a high level. This is a standard CTS without no complicating issues.
Have you seen reference material regarding this?
 
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Kittykat1 said:
He states that the diagnosis of carpal tunnel is a "chronic illness with severe exacerbation, progression or treatment side effects". I informed him that this column was for serious, life threatening issues but he still feels it's a high level. This is a standard CTS without no complicating issues.
Have you seen reference material regarding this?
Click to expand...


Have you tried looking in the 95/97 guidelines? The diagnosis code alone isn't the only factor. (I code oncology - if it was just about the diagnosis code, all of my visits would be Level 5. However, that's definitely not the reality!)

For example, in the 95/97 guidelines (p 15 of the 95, p 43 of the 97) there's a table that might be useful

High: "One or more chronic illnesses with severe exacerbation, progression, or side effects of treatment" corresponds with the management option "Elective major surgery (open, percutaneous or endoscopic) with identified risk factors"

You're saying that it's a standard surgery with no complicating issues, which would more closely match the Moderate management option descriptions: "Minor surgery with identified risk factors" or "Elective major surgery (open, percutaneous or endoscopic) with no identified risk factors"
 
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