Wiki Infertility

[treppert]

I don’t see any discussion on infertility. Would anyone have a cheat sheet for E&Ms, such as an audit form? Most patients come in with the issue of not getting pregnant for a few years with no other dx. Tests and labs will be ordered. The providers document 45-60 minutes for the initial consult which is usually telemedicine. Not a lot of documentation to substantiate a 99204 or 99205. In my opinion infertility is low risk when there’s no other dx that would affect conception such as PCOS, fibroids, etc. Any assistance is very much appreciated!

 

[jkyles]

Hi there, is there a reason they don't want to code based on time? If they're performing at least 45 minutes of care on the date of the encounter that's a level 4.

For MDM, I recommend discussing risk with the provider, keeping in mind that risk includes includes the risk of treatment ordered or discussed. One of the things the AMA has stressed with the new coding system is that many conditions aren't always any one thing and the provider gets to decide. That's why they don't have that many examples under risk.

 

[treppert]

Thank you for the response! Every note lists a time they spent during the visit. I have always coded by time. There are a few insurances that will downcode the level until notes are sent. Sometimes I feel that the time isn’t always appropriate according to what is documented. Would I still code it based on time? I want to prevent the clinic from being put on “high alert” if you will with these insurances.I thought it was the choice of the provider to either go by time or MDM? Thank you for any suggestions you have. Much appreciated!

 

[jkyles]

According to the CPT manual the provider does decide whether to code based on time or MDM, and you can make that choice for each visit, if you want. I have not seen a payer policy that prohibits or restricts time-based coding.

So far as documentation is concerned, I'm not sure I understand. The documentation for time is not the same as for MDM. The provider needs to document the exact total time they spend on the date of the encounter, based on the list of nine tasks. You'll need to check individual payers for any additional documentation requirements. At the very least the provider should document what they did.