Jfraska
Contributor
Hi everyone, I recently started my first coding job!!!
The biggest that has been tripping me up is MDM and medical necessity
For the number of dx or treatment options, the points are given for dx that ARE CURRENTLY being treated right? For example, if someone is being seen for type I diabetes but they have another chronic disease, such as Austism and/or cerebral palsy that is mentioned and in the dx list BUT it was not treated or addressed. Does this get a point just for being a stable, chronic issue? Or no because it has nothing to do with, in this case, the endo clinic visit for f/u of type 1 DM?
Regarding the risk chart, would the issues above contribute to risk--2 or more stable chronic illnesses, etc?
I was also told that, using this same example, that if a provider is billing a 99214 but the coding comes out to C,C,L AND the patient has been seen within 6 months and that visit was also a 99214 and this current visit had little/no workup and they wanted to follow up with them in another six months that you would look at necessity and bill that 99214 instead of 99215. Same goes for if the physician down or upcodes. Is this just something you get used to based on your specialty that you code and your facility?
(I work in pro-fee at a hospital but code clinical endo)
I hope I made everything clear Thanks
The biggest that has been tripping me up is MDM and medical necessity
For the number of dx or treatment options, the points are given for dx that ARE CURRENTLY being treated right? For example, if someone is being seen for type I diabetes but they have another chronic disease, such as Austism and/or cerebral palsy that is mentioned and in the dx list BUT it was not treated or addressed. Does this get a point just for being a stable, chronic issue? Or no because it has nothing to do with, in this case, the endo clinic visit for f/u of type 1 DM?
Regarding the risk chart, would the issues above contribute to risk--2 or more stable chronic illnesses, etc?
I was also told that, using this same example, that if a provider is billing a 99214 but the coding comes out to C,C,L AND the patient has been seen within 6 months and that visit was also a 99214 and this current visit had little/no workup and they wanted to follow up with them in another six months that you would look at necessity and bill that 99214 instead of 99215. Same goes for if the physician down or upcodes. Is this just something you get used to based on your specialty that you code and your facility?
(I work in pro-fee at a hospital but code clinical endo)
I hope I made everything clear Thanks