Wiki ROS question

[cdelappe]

I am currently taking the E/M university course which is called the Coder Curriculum.
In the lesson on requirements for coding 99223 the sample patient is unable to provide a history.
The instructor of the course has indicated that the "caveat" allows the provider to take credit for a complete ROS.
"Caveat" is 1995 and 1997 DG: Record should describe patient's condition or other circumstance which precludes
obtaining a history. Can other coders confirm that this is correct? I have heard of it before but never had to
rely on the statement to determine an E/M level.

 

[jdibble]

I am currently taking the E/M university course which is called the Coder Curriculum.
In the lesson on requirements for coding 99223 the sample patient is unable to provide a history.
The instructor of the course has indicated that the "caveat" allows the provider to take credit for a complete ROS.
"Caveat" is 1995 and 1997 DG: Record should describe patient's condition or other circumstance which precludes
obtaining a history. Can other coders confirm that this is correct? I have heard of it before but never had to
rely on the statement to determine an E/M level.

At a seminar with our local MAC, which is Novitas, they had instructed us that as long as the doctor documented the reason that the history or a portion of the history (ROS or PFSH) was unobtainable (patient unconscious) and what measures were used to obtain any information that was received (i.e. - spoke with family member, reviewed old charts), then the provider could take credit for a comprehensive history. However, just because the history is comprehensive does not guarantee that the level would be a high level code (99223) as the other elements would still have to meet the requirements of that level (Comprehensive exam and High MDM).

Other Medicare carriers may have a different take on this however, so I would verify with your carrier how they would handle this situation.

Hope that helps!

 

[cdelappe]

Consult Question

Thanks for your comments jdibble! Here's another one I need help with:

Example: Pt in hospital following knee replacement so Ortho provider is admitting provider. He consults the Internal Med provider who usually sees the patient in the office
because the patient's HTN readings are rising. Internal Med provider increases medication patient is on and orders labs.

The E/M course I am taking (from E/M University) indicates this can be billed (for non-MCR patient) as 99253.
I don't understand how a provider can "consult" on one of his own patients. Can anyone explain this?

 

[mhstrauss]

Thanks for your comments jdibble! Here's another one I need help with:

Example: Pt in hospital following knee replacement so Ortho provider is admitting provider. He consults the Internal Med provider who usually sees the patient in the office
because the patient's HTN readings are rising. Internal Med provider increases medication patient is on and orders labs.

The E/M course I am taking (from E/M University) indicates this can be billed (for non-MCR patient) as 99253.
I don't understand how a provider can "consult" on one of his own patients. Can anyone explain this?

Consult codes don't have the same New/Established rules. As long as the requirements of a Consult were met, the IM provider can bill a consult on his established patient.

 

[cdelappe]

Consult Question

Consult codes don't have the same New/Established rules. As long as the requirements of a Consult were met, the IM provider can bill a consult on his established patient.

Thanks very much! I am learning a lot in this E/M course!