ladybird
Contributor
My Endo Dr. gives me the following for a hospital subsequent visit and he is billing for a 99232. I am waivering on either a 99231 or no billing, due to no exam, can't tell if he saw the patient? Can anyone offer their advice?
Progress note - Endocrine consult request per DR._______ regarding apparent hypoglycemia of ? Etiology in a 25 yo female patient with recent recurrent seizures and blood glucose from available records of 68 mg/dl. Blood glucose levels since admission 89 - 116 mg/dl. No current signs of sepsis, chronic adrenal insufficiency, hypothalamic-pituitary disorder, underlying neoplasm, or unusual drug related hypoglycemia or increased alcohol intake. Recent blood glucose levels noon = 107, pm = 115, hs = 115, am = 116 and noon = 103 mg/l. Normal serum cortisol 15.8 and sed rate = 7. Currently on D5W in NS 75 cc/hr with blood glucose levels pm = 114 and am = 133 mg/dl. Have started tapering down the IV dextrose to 50cc/hr to determine if this is sustained vs transient hypoglycemia. Resulting blood glucose levels hs = 115 and am= 90 mg/dl. Will continue to monitor on IV dextrose 25 cc/hr.
Progress note - Endocrine consult request per DR._______ regarding apparent hypoglycemia of ? Etiology in a 25 yo female patient with recent recurrent seizures and blood glucose from available records of 68 mg/dl. Blood glucose levels since admission 89 - 116 mg/dl. No current signs of sepsis, chronic adrenal insufficiency, hypothalamic-pituitary disorder, underlying neoplasm, or unusual drug related hypoglycemia or increased alcohol intake. Recent blood glucose levels noon = 107, pm = 115, hs = 115, am = 116 and noon = 103 mg/l. Normal serum cortisol 15.8 and sed rate = 7. Currently on D5W in NS 75 cc/hr with blood glucose levels pm = 114 and am = 133 mg/dl. Have started tapering down the IV dextrose to 50cc/hr to determine if this is sustained vs transient hypoglycemia. Resulting blood glucose levels hs = 115 and am= 90 mg/dl. Will continue to monitor on IV dextrose 25 cc/hr.