I know a Doctor that uses a chart he got from his residency and it leads him to billing many 99205 visits. I am trying to figure out if he is up coding without realizing it.
He goes off of three things: chief complaint is new to him, but may not be new to patient; medical records reviewed (in front or not in front of patient) and Medical Decision Making. If he prescribes opiates then he thinks he can raise the office visit due to high complexity MDM.
So we often get 99205 for a two diagnosis patient with just myofascial pain and high drug monitoring, while the provider only spent 30 minutes with the patient face to face.
Is this right?
He goes off of three things: chief complaint is new to him, but may not be new to patient; medical records reviewed (in front or not in front of patient) and Medical Decision Making. If he prescribes opiates then he thinks he can raise the office visit due to high complexity MDM.
So we often get 99205 for a two diagnosis patient with just myofascial pain and high drug monitoring, while the provider only spent 30 minutes with the patient face to face.
Is this right?