EMcoder13
Contributor
I need help with this problem.
I have a pediatric provider in our practice that will charge a 99215 for just about every ADD or ADHD med rechecks for children under 18 years old. These patients come in at least 4 times a year or more.
This is his reasoning: Every appointment he does a complete review of systems and family history, he examines every body/organ system because the medicine could effect any part of the body. Presenting problem he considers: acute or chronic illness that could pose a threat to life or body function (because of the ADHD medication they are on) and management options he considers: drug therapy requiring intensive monitoring for toxicity. I have talked to a few auditors and one could see his reasoning and a few said you only need to do the ROS and EXAM that pertains to the reason for the visit which is med recheck. They also felt that ADHD is not a life threatening illness or that drug therapy requiring intensive monitoring for toxicity is not appropriate. (compared to a person dying of cancer going through chemo and taking very toxic meds for the cancer and pain).
Any comments or documentation supporting this either way would be appreciated.
I have a pediatric provider in our practice that will charge a 99215 for just about every ADD or ADHD med rechecks for children under 18 years old. These patients come in at least 4 times a year or more.
This is his reasoning: Every appointment he does a complete review of systems and family history, he examines every body/organ system because the medicine could effect any part of the body. Presenting problem he considers: acute or chronic illness that could pose a threat to life or body function (because of the ADHD medication they are on) and management options he considers: drug therapy requiring intensive monitoring for toxicity. I have talked to a few auditors and one could see his reasoning and a few said you only need to do the ROS and EXAM that pertains to the reason for the visit which is med recheck. They also felt that ADHD is not a life threatening illness or that drug therapy requiring intensive monitoring for toxicity is not appropriate. (compared to a person dying of cancer going through chemo and taking very toxic meds for the cancer and pain).
Any comments or documentation supporting this either way would be appreciated.