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:
Current medications:
None.
PHYSICAL EXAM:
Temp: 98.4 °F (36.9 °C)
Heart Rate: 87
Resp: 18
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.
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:
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.
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 | ||
| Allergen | Reactions | |
| • | Penicillins | Hives |
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)* |
| 03/13/20 | 98/62 (80 %, Z = 0.84 / 85 %, Z = 1.02)* |
| 10/15/19 | 102/67 (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: | |
| 04/17/20 | 3' 5.22" (1.047 m) (<1 %, Z= -3.28)* |
| 03/13/20 | 3' 5.14" (1.045 m) (<1 %, Z= -3.22)* |
| 02/17/20 | 3' 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 stature | Growth 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.