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CC Behavior Issues

  1. #1
    Seacoast- Dover New Hampshire
    Default CC Behavior Issues
    Medical Coding Books
    Pt came in for the above complaint. Provider spent 45 mins face to face. Brief synopsis. pt has difficulty in school,out burst and oppostional type behavior toward certain individuals at school. Some of the injustices are warranted. Some other issues revolve against brother who is younger. Pt acts aggressively when confronted. No Sucidial ideation or depression symptoms, a Beck inventory filled out . Strong need for family counseling. Cognitive behavioral therapy to obviate some of the escalations that are going on. Plan is to sort out . Further sit down discussion planned. To see Dr B.

    There was not an examination done. Provider coded 99214, I believe that a 99213 w/99254 should be coded. There is more to the note that I have listed here. Thanks in advance.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Milwaukee WI
    Default Counseling / Coordination of Care
    If more than 50 % of the total time spend was in counseling/coordination of care, then the appropriate code to use based on total time of 45 minutes would be 99215.

    I don't see how you could bill an inpatient consult (99254), as patient came into the office. But maybe that's a typo and you mean 99354 prolonged service.

    You would not bill prolonged service because when you are using time for counseling/coordination of care you code to the highest level supported by the time, and only code prolonged service if you have at least 30 minutes more than the time required for the highest level of service. 99215 requires 40 minutes, so you would need at least 70 minutes total to have an additional 30 minutes for prolonged service (99354)

    F Tessa Bartels, CPC, CEMC

  3. #3
    Seacoast- Dover New Hampshire
    My thinking process( there I go thinking) that there was an expanded problem and decision making low complexity.This is where I come up with the 99213. And yes that was a typo s/b 99354. Also the provider did not state that the visit was 50%, he only stated 45 mins spent with the pt face to face. But as I look thru 95 guidelines, I see your point. Thank you for all your help,Tessa.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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