Wiki Pituitary stimulation testing. Help :/

KoBee

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HELP :/

We are getting denials from Blue Cross for Prolonged services CPT 99358/99359, not sure if our provider should be billing all these codes. Or any resources anyone could recommend to better understand how to code.

Patient is a 7 yr old.

Provider is billing

99214
96372
J1610
36415 x6
99358
99359 x4
82962


4/17/2020
7  y.o. 0  m.o. male
Patient presents for Pituitary stimulation testing.

SUBJECTIVE:
Patient feels well, no symptoms to suggest any infection.

PMH:
   
Allergies
AllergenReactions
PenicillinsHives


Current medications:
None.

PHYSICAL EXAM:
Temp: 98.4 °F (36.9 °C)
Heart Rate: 87
Resp: 18

  
BP Readings from Last 3 Encounters:
04/17/20(!) 89/56 (45 %, Z = -0.11 /  60 %, Z = 0.24)*
03/13/2098/62 (80 %, Z = 0.84 /  85 %, Z = 1.02)*
10/15/19102/67 (91 %, Z = 1.32 /  97 %, Z = 1.89)*

*BP percentiles are based on the 2017 AAP Clinical Practice Guideline for boys

Blood pressure percentiles are 45 % systolic and 60 % diastolic based on the 2017 AAP Clinical Practice Guideline. This reading is in the normal blood pressure range.

  
Ht Readings from Last 3 Encounters:
04/17/203' 5.22" (1.047 m) (<1 %, Z= -3.28)*
03/13/203' 5.14" (1.045 m) (<1 %, Z= -3.22)*
02/17/203' 3.49" (1.003 m) (<1 %, Z= -3.95)*

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

  
Wt Readings from Last 3 Encounters:
04/17/20(!) 30 lb (13.6 kg) (<1 %, Z= -5.14)*
03/13/20(!) 30 lb 3.2 oz (13.7 kg) (<1 %, Z= -4.92)*
02/17/20(!) 29 lb 12.8 oz (13.5 kg) (<1 %, Z= -5.01)*

* 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 12.41 kg/m².
<1 %ile (Z= -3.59) based on CDC (Boys, 2-20 Years) BMI-for-age based on BMI available as of 4/17/2020.
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:


1.Short statureGrowth Hormone, Serum, Six Specimens
Poct glucose


TREATMENT:

1.  Pituitary testing performed with:
Glucagon 0.4 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 12:15 PM.
 
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