Number & Complexity of problems addressed

Worxs43

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Good Morning,
How would you look at the following diagnosis codes based on level. Found in office during a conversation some ppl code much higher than I thought for these diagnosis codes when presented without systemic symptoms, moderate. Just worried I may be coding low but at the same time I don't feel that I am.

Contact dermatitis if I see it continues to spread or some drainage: low,
Acute otitis media no fevers, no drainage: low,
Contusion: low
Conjunctivitis: low
Cellulitis: moderate
Anxiety with simple care: moderate
Hemorrhoid: moderate


Let me know when you have the time.


Thank you:confused:
 
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Farrellandrews

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I would love to know too as I code family practice and we get this scenario a lot. I would not go above 99213 because of MDM/RX management.
 

csperoni

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The CONDITION of the problem, not just the problem itself is key in determining the level.
If all of the problems listed are presenting as stable without systemic systems, I don't see how you could reach moderate unless there are 2 or more problems.
From the AMA guidelines:
Moderate
• 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment; or
• 2 or more stable chronic illnesses; or
• 1 undiagnosed new problem with uncertain prognosis; or
• 1 acute illness with systemic symptoms; or
• 1 acute complicated injury

The problems listed without the status only give part of the picture.
 

Worxs43

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I would love to know too as I code family practice and we get this scenario a lot. I would not go above 99213 because of MDM/RX management.
:) Agree. When the conversation came up my co-worker told me if a patient where to come in for aom with a slight cough no other signs/symptoms and given a prescription 99214/04.
Also she had mention if a patient presents with ringworm not spreading just itching and a prescription given she would code a 99203. Honestly to me I think this would be coded a 99202, just because a prescription is given doesn't mean it would be considered low....
 

Worxs43

Networker
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59
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The CONDITION of the problem, not just the problem itself is key in determining the level.
If all of the problems listed are presenting as stable without systemic systems, I don't see how you could reach moderate unless there are 2 or more problems.
From the AMA guidelines:
Moderate
• 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment; or
• 2 or more stable chronic illnesses; or
• 1 undiagnosed new problem with uncertain prognosis; or
• 1 acute illness with systemic symptoms; or
• 1 acute complicated injury

The problems listed without the status only give part of the picture.
Hello Csperoni :)
Thank you for your response. Honestly I was thinking along the same lines that I only see the scenarios as low as there are no other signs/symptoms.
For example co-worker stated that if a patient were presenting acute otitis media and a slight intermittent cough, Dr give a prescription would level 99204/14 but to me it seems to be a 99203/13.
The last 3 scenarios of cellulitis, hemorrhoid and anxiety most of the time when I run across this presenting problem I have found it to be an exacerbation or chronic.
 
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