Wiki WHat EM code would you assign?

[amexnikki23]

Here are the specs:

Dx:Cough - 786.2 (Primary)
Allergic rhinitis due to allergen - 477.8
POSTNASAL DRIP - 784.91

TX/Plan: cxr, allergy med & nasal spray

Provider chose 99214, however, would you consider the cough and PND to be an actual "condition" (to count 3 acute conditions) or are these just contributing symptoms since the cough is due to the PND and the PND is due to the allergic rhinitis?

 

[emcee101]

Level 4, say what?!?!

As you probably already know, E/M coding for an established patient OV relies on more than just what, and how many, diagnosis codes are selected. There seems to be more than one questions here; one about counting MDM points, another regarding proper diagnosis coding and yet one more regarding the overall E/M level selection.

Per ICD-9 guideline I.B.7
7. Conditions that are an integral part of a disease process
Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

The PND and the cough are both symptoms that commonly occur with allergic rhinitis and thus should not be coded separately. Thus I would also not count them as three separate conditions in the MDM portion of the encounter for an E/M code just to (presumably) raise the level of service.

In my opinion, more importat than coding MDM points or diagnosis coding is the fact that the provider chose a 99214 for a simple issue like allergic rhinitis. You may want to remind him about the nature of the presenting problem/medical necessity requirements of E/M being a contributing factor when choosing an appropriate level of E/M code.

Per CMS: "Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported."
https://www.cms.gov/transmittals/downloads/r178cp.pdf

 

[amexnikki23]

thank you

Thank you for your response. Im new at this position and second guess myself a lot due to established protocol already in place for coders. I agree with your rationale.

I was hoping you could help me in another area as I have called and emailed AAPC to no avail.

How do you get your responses to posts/threads? I had no idea that you even answered my post. Is there a way to set up notifications so that you know when a member has replied to your post?

Thanks!

 

[JEYCPC]

At the top of the page is a "thread tools". When you click it a drop down will appear with choices. One of the choices is to subscribe to thread.

 

[amexnikki23]

thanks