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Wiki Level of E/M for New PT Birth Control Initiation

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2
Location
Waverly, KS
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One One of my providers is stating that for all New Patients that are seen for request for Birth Control, specifically speaking about OCP's, those visit should be a 99204 d/t risk. I understand that a patient may have non-gyn related dx's that are managed by another physician that would be applicable and therefore the risk would be increased and/or other medications that would too increase risk. However I am not so convinced for those healthy patients that are being seen for birth control all fall into 99204. Example: Healthy 18yo presents for birth control. OCP's , Injectables, IUD/S's, Implants, etc are discussed with the patient along with risks associated with such devices/drugs. Admittedly they are not spending 45min or more with the patient during these visits, so billing based on time doesn't get them to a level 4. My provider has discussed this such senario with a fellow OBGYN she recently graduated with and they are using a level 4 for all birth control initiation visits. They've also spoken to several local providers, both OBGYN's and FP's all of which are stating they always bill a 99204 for New Patient Birth Control Visits. My physician states that these visits should all be considered "undiagnosed new problems" with "prescription management" thus all should be a 99204 visit. Otherwise if not an "undiagnosed new problem" it should be identified as "Chronic Fertility". Can anyone provide and documentation of what is the appropriate way to dissect these visits. Thanks!of my providers is stating that for all New Patients that are seen for request for Birth Control, specifically speaking about OCP's, those visit should be a 99204 d/t risk. I understand that a patient may have non-gyn related dx's that are managed by another physician that would be applicable and therefore the risk would be increased and/or other medications that would too increase risk. However I am not so convinced for those healthy patients that are being seen for birth control all fall into 99204. Example: Healthy 18yo presents for birth control. OCP's , Injectables, IUD/S's, Implants, etc are discussed with the patient along with risks associated with such devices/drugs. Admittedly they are not spending 45min or more with the patient during these visits, so billing based on time doesn't get them to a level 4. My provider has discussed this such senario with a fellow OBGYN she recently graduated with and they are using a level 4 for all birth control initiation visits. They've also spoken to several local providers, both OBGYN's and FP's all of which are stating they always bill a 99204 for New Patient Birth Control Visits. My physician states that these visits should all be considered "undiagnosed new problems" with "prescription management" thus all should be a 99204 visit. Otherwise if not an "undiagnosed new problem" it should be identified as "Chronic Fertility". Can anyone provide and documentation of what is the appropriate way to dissect these visits. Thanks!
 
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