Need answers for billing 99204 & 99214

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I have been running around in circles trying to get a few questions answered by an E/M coding expert...I have contacted my local chapter many times, old professors, etc and have gotten nowhere... kinda frustrating...I have Read all the guidelines/watched all PP presentations but nothing answers specifics in the new criteria...

So maybe someone here can answer these questions:

1. Is Body Composition considered a 'unique test'?
2. Is a pregnancy test considered a 'unique test'?
3. What qualifies as a 'unique source'?
4. Under Risk of complications column, if a patient is being seen for medication management while on a stimulant, as long as theres proper documentation in regards to the risk of taking said stimulant, can that can qualify as Moderate level?

I am the only one at my job that does coding and I do not have a mentor/supervisor that I can go to with questions so I would really appreciate some guidance as I have been trying to get these answered for some time.

Thanks so much!
Victoria Emmerich, CPC
vicklinzz@yahoo.com
 
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saddie2k

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I may not be the best help but a unique test is defined as each test that is assigned a reportable CPT code. If performed in house and you will be reporting that CPT for separate payment then you cannot use it towards data.
Unique source is defined as a physician or other qualified healthcare professional who is NOT in the same group practice or is of a different specialty/subspecialty.
The exact definitions for both of these terms can be found on AMA website. As far as risk goes, prescription medication management usually falls under moderate risk. Documentation must be present to justify the management. It can't just say "continue meds" or something similarly generic. I am not sure about the involvement of a stimulant...can you discuss with your physician?
Hope that helped at least a little!
 
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