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coding based on time, 99215 or 99354

  1. #1
    Default coding based on time, 99215 or 99354
    Medical Coding Books
    We have a child patient who need's keloid injections but every time she comes, a lot of time is spent struggling with her to do the injection. She throws a tantrum and vomits every time but this time at least 45 minutes was spent with the patient doing this and telling the patient's mother she must bring her child early in the morning without eating breakfast because she throws up every time. Problem focus history and exam since it's a returning patient for the same problem (keloid injections to finger)

    Would I code this as 99215 just based on the 45 minutes spent with struggling with the patient and cleaning up her vomit.

    Or

    Do I code it as 99212 + 99354 for prolonged service. Do I include 11900 as well?

    Thanks

  2. #2
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    This is a scheduled injection so you cannot charge an office visit. You can use the procedure code with a 22 modifier for the prolonged time and if the combative nature of the patient is documented then add that to you dx codes.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Quote Originally Posted by mitchellde View Post
    This is a scheduled injection so you cannot charge an office visit. You can use the procedure code with a 22 modifier for the prolonged time and if the combative nature of the patient is documented then add that to you dx codes.
    What code would I use for the combative nature? I'm finding codes under metal problems but don't really want to use those since that's not really the case.

    I see 294.11, it includes combative behavior but patient doesn't have Dementia.
    Last edited by JesseL; 10-19-2014 at 02:25 PM.

  4. #4
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    I agree with Debra. Also look at 312.9 for the combative behavior.
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  5. #5
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    Look under the 799 codes to see if one of those fit. They are symptom codes.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Quote Originally Posted by mitchellde View Post
    Look under the 799 codes to see if one of those fit. They are symptom codes.
    I don't think I can use the 799 codes, I noticed they're categorized as 'Other ill-defined and unknown causes of morbidity and mortality"
    Last edited by JesseL; 10-20-2014 at 08:26 AM.

  7. #7
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    Quote Originally Posted by mzkandy83 View Post
    I agree with Debra. Also look at 312.9 for the combative behavior.
    Thanks, I think this could work, even thought I don't want to call the patient mental.

  8. #8
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    Quote Originally Posted by mitchellde View Post
    This is a scheduled injection so you cannot charge an office visit. You can use the procedure code with a 22 modifier for the prolonged time and if the combative nature of the patient is documented then add that to you dx codes.
    Thanks for the modifier 22 tip Debra, hope we can get additional reimbursement for this.

  9. #9
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    Quote Originally Posted by JesseL View Post
    I don't think I can use the 799 codes, I noticed they're categorized as 'Other ill-defined and unknown causes of morbidity and mortality"
    That is correct, and 799.22 is irritability and 799.21 is nervousness.
    Morbidity is just the incidence of disease or conditions that complicated a disease.

    Debra A. Mitchell, MSPH, CPC-H

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