Wiki Help needed Peds 99215 for ADHD med check

[EMcoder13]

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.

 

[mitchellde]

My problem is that I am not the doctor, (coders in general) It is out of our area of expertise to decide what is "appropriate" as far as the extent of the exam and the things he is looking for and the rationale for same. What we have to concern ourselves with is does the documentation meet the level. Since there is so much subjectivity involved with MDM I do think it is within the physicians ability to determine the definition of minimal, limited, moderate, extensive with respect to # of dx and amount and complexity of information so long as it is applyed the same way for all patients and is documented sufficiently. So given all that if the documentations meets the requirements for a 99215 then it is that level. Just because an auditor does not feel it is life threatening is insufficient reasoning, and quite frankly out of their level of expertise to evaluate.