Wiki tick bite level

[wynonna]

How are we billing for office visit when the chief complaint is a tick bite and the patient has no symptoms, but the provider prescribes doxycycline prophylactically?
thank you
To me it is a 99212 or 99213 for established.
Should we bill level 2 or level 3?
We are internal medicine and we're seeing a lot of patients presenting with tick bites and doxy is Rx given.

 

[Pathos]

What does the rest of the note say? Don't forget that any E/M level requires a History and/or Exam apart from the Medical Decision Making.

Also, just because the provider prescribes an Rx (some patients won't leave without a prescription), does not automatically make the visit Moderate or even Low. If we are using the Marshfield Clinic tool for the MDM section, combined with CMS E/M guidelines then we are looking at a Straightforward/Minor problem under Diagnosis and/or Management Options. If the tick bite is asymptomatic, then I would be hesitant to give this anything higher.

Depending on what the History and/or Exam land on, this would also sway the E/M level. Mind you that some payers focus on the MDM as being one of the deciding factors for Established E/M visits, while others would pick any two of the three.

All this said, medical necessity is always king and would overrule any point system.

 

[thomas7331]

I agree with Pathos. Treatment of an uncomplicated and asymptomatic tick bite in most cases is straightforward MDM because the provider is simply following the CDC's recommendations for how to prevent a potential Lyme disease. However, the history, exam and MDM may vary depending on the individual patient needs and the fact that a prescription is going to be issued. You should select the level based on the documentation of all of the elements in the note, as per the CPT guidelines.