fowens
Networker
Hi all, I need help with a coding debate... I posted this to E/M board, but I really want some compliance perspective on this....
We all know that medical necessity is the over-arching criteria for selecting E/M codes... My question is regarding prescription drug management and how this plays into medical necessity.
Here's the scenario: An otherwise healthy 30 year old presents with a sore throat to their PCP for established acute visit. They present with sore throat and are given a strep test that is positive. An simple antibiotic is written. A detailed history and expanded exam is performed.
The presenting problem even though it is new is uncomplicated so medical necessity should direct the provider toward low decision making. Which so far in this case would support a 99213. So does counting prescription drug management for writing a Rx for an antiobiotic alone justify a 99214 for this type of visit?
Do we automatically count Prescription Drug management every time a Rx is written without regard for medidcal necessity? Is there anything in writing that defines prescription drug management when it comes to risk?
We all know that medical necessity is the over-arching criteria for selecting E/M codes... My question is regarding prescription drug management and how this plays into medical necessity.
Here's the scenario: An otherwise healthy 30 year old presents with a sore throat to their PCP for established acute visit. They present with sore throat and are given a strep test that is positive. An simple antibiotic is written. A detailed history and expanded exam is performed.
The presenting problem even though it is new is uncomplicated so medical necessity should direct the provider toward low decision making. Which so far in this case would support a 99213. So does counting prescription drug management for writing a Rx for an antiobiotic alone justify a 99214 for this type of visit?
Do we automatically count Prescription Drug management every time a Rx is written without regard for medidcal necessity? Is there anything in writing that defines prescription drug management when it comes to risk?