Pituitary Stimulation Testing (growth hormone)

michiboo

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We a have provider who bills all these codes, wondering if the provider should be even coding all these codes and is allowed or is there specific guidelines because I can't find anything saying the provider cannot.

99214
99358
99359
36415


11  y.o. 0  m.o. male

Patient presents for Pituitary stimulation testing.

SUBJECTIVE:
Patient feels well, no symptoms to suggest any infection.
PMH:
No Known Allergies

Current medications:
None.

PHYSICAL EXAM:
Temp: 99.3 °F (37.4 °C)
Heart Rate: 75

  
BP Readings from Last 3 Encounters:
11/01/19​
99/68 (58 %, Z = 0.20 /  77 %, Z = 0.75)*​
09/26/19​
103/68 (74 %, Z = 0.66 /  78 %, Z = 0.77)*​
07/31/19​
101/69 (67 %, Z = 0.45 /  81 %, Z = 0.90)*​

*BP percentiles are based on the August 2017 AAP Clinical Practice Guideline for boy​
Blood pressure percentiles are 58 % systolic and 77 % diastolic based on the August 2017 AAP Clinical Practice Guideline.

  
Ht Readings from Last 3 Encounters:
11/01/19​
4' 2.43" (1.281 m) (1 %, Z= -2.28)*​
09/26/19​
4' 2.1" (1.273 m) (<1 %, Z= -2.34)*​
07/31/19​
4' 2.35" (1.279 m) (2 %, Z= -2.15)*​

* Growth percentiles are based on CDC (Boys, 2-20 Years) data.​
  
Wt Readings from Last 3 Encounters:
11/01/19​
70 lb 6.4 oz (31.9 kg) (25 %, Z= -0.67)*​
09/26/19​
68 lb 9.6 oz (31.1 kg) (22 %, Z= -0.76)*​
07/31/19​
66 lb 9.6 oz (30.2 kg) (20 %, Z= -0.84)*​

* Growth percentiles are based on CDC (Boys, 2-20 Years) data.​

HC Readings from Last 3 Encounters:
No data found for HC​
Body mass index is 19.46 kg/m².
80 %ile (Z= 0.84) based on CDC (Boys, 2-20 Years) BMI-for-age based on BMI available as of 11/1/2019.

HEAD:  Normocephalic.
EYES:  PRRERL. Media clear. Fundi normal OU.
ENT:  TM's normal AU. Pharynx clear.
NECK:  Thyroid normal to palpation. No adenopathy.
CHEST:  Clear to auscultation.
HEART:  Quiet precordium. No murmurs heard
ABDOMEN:  Soft without masses.  Bowel sounds normal
EXTREMITIES:  Pulses: normal bilaterally, upper and lower extremities. Dysmorphic features: None.
NEUROLOGIC: Cranial nerves intact. DTRs symmetric.  Ankle jerk relaxation phase normal BLE. Babinski absent bilaterally.
GENITALIA: Not examined.

ANALYSIS/IMPRESSION:
TREATMENT:
1.  Pituitary testing performed with: Glucagon 1 mg IM
2.  Patient tolerated the test without problems; monitored throughout by nursing personnel and myself.
3.  Follow up recommended: After laboratory studies reported.
4. The above mentioned patient was under my care for prolonged visit during GH stimulation testing from 8:40 AM to 12:05 PM.
 
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