Rheumatology 99214

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Strafford, MO
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I have a couple of Rheumatolgiest that see alot of RA patients. When they come in for a follow up they are wanting to bill level fours. If the patient is in stable condition and nothing is being changed with thier meds I don't agree that a level four would be appropriate.

However if a patient comes in and thier RA is worseing and they are having to make changes to thier meds I can understand. When we are auditing thier visits though it is our policy to make medical decision making one of the two components to drive the E/M level. Since it is only one problem worsing and they change a med and run a lab we are only getting a low complexiaty for the MDM. The Rheumatolgiest do not agree with this stating that when looking at the bell curves the national average is mostly level fours and that thier patients are a higher complexity.

Has anybody else ran into this issue and what have you done?
 
Hi,
I agree with your MD'S, just because they are not changing the meds they are still having the patient to come back and manage their meds, they are asking the patient how do you feel, is it working, do you have any side affects. All you need for an established patient is 2 of 3, if the provider is getting a detailed history, or detailed exam they certainly are there for their MDM since it would be considered high (requiring intensive monitoring for toxicity). That is if the patients are taking these toxicity drugs. If the MD is also counseling the patients for what ever the reason might be due to RA and other manifestations of the disease they should document time spent using the correct verbiage of coarse. I rarely see a patient come into our practice that does not require to MD to at least follow up old test results (which give you points) x-ray results (which if they visualize these themselves and mention it gives them points) Not sure what tool you use to decide your MDM but for the most part the MDM if it is dictated correctly they could get 99214,99215 easily. Hope this helps
 
If they have read and understand the requirements for the visits I would let them decide. If you're not sure they fully understand maybe give them a print out. We have a lot of RA patients in follow up that we bill 99214. I would say I see as many 99213s as 99214s. Some patient's diseases are more advanced and complicated, or effect other parts of their health that may be treated by other physicians.
 
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