Wiki Urine drug screen and E&M codes

[574coding]

Hello,
One of our providers thinks we can code up a level due to pain management visit with a urine drug screen per the AMA. We do bill for the urine drug screen. I do not think that a routine visit w/screen will support a higher E&M code without meeting all the criterias for the level of service. I have done research and have not found anything to support this. Does anyone have any information they can pass along to me to support or not support coding a higher E&M visit to pass along to my provider?
Thank you.

 

[dwaldman]

The number of possible diagnoses and/or the number of management options that must be considered; ❖

The amount and/or complexity of medical records, diagnostic tests, and/or other information that must be obtained, reviewed, and analyzed; and

If you look at 99213 versus 99214 for example:

The medical decision making for an established patient with one or two stable conditions with order and/or review of urine drug screen with prescription also being provided is not going to meet moderate decision making required for a 99214.

The review or order of clinical lab test only provides 1 point and does not cross the service over to a level four alone in itself

http://www.aafp.org/fpm/2005/0900/p52.html

The above link is from Peter Jensen, MD, CPC which goes over the documentation requirements of 99213 vs 99214.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/EMDOC.html

The above link has the following references:

Evaluation and Management Services Guide (November 2014) ? This guide is designed to provide education on evaluation and management services. It includes the following information: medical record documentation, evaluation and management billing and coding considerations, the "1995 Documentation Guidelines for Evaluation and Management Services" and the "1997 Documentation Guidelines for Evaluation and Management Services."
?1995 Documentation Guidelines for Evaluation and Management Services.
?1997 Documentation Guidelines for Evaluation and Management Services.

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I think when you look at the criteria of the differences level 3 versus level 4 services for established patients, without additional data being reviewed or ordered, a urine drug screen alone will not increase the level of service from a level 3 to a level 4, if that were the levels in question.