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Thread: 99223 or 99221?

  1. #1
    Join Date
    Apr 2007

    Smile 99223 or 99221?

    AAPC: Back to School
    Good Morning, I need assistance with this -

    This was coded a 99223, but I get a 99221.

    CC: Shortness of Breath

    HPI: 67-year old male with a past medical hx of CHF, who was admitted a few months ago for the same complaint. At this time, the pt developed a cough two days prior to admission. He denies fever. At the same time, he also noted some shortness of breath. The shortness of breath increased gradually even at rest. The patient had been noticing leg swelling for a couple of days as well that had been increasing gradually. He denies chest pain, fever, shaking chills, nausea or vomiting, diarrhea or abdominal pain. He came to the ER for further evaluation.

    PMHx: HTN, CHF, DM, Arthritis
    FMHX: positive for HTN
    SHX: denies smoking, alcohol or drug use

    PE: Vitals, HEENT, NECK, CV, Resp, ABD, CNS

    Labs: X-Rays

    Plan: admit to progressive care unit, request Cardio consult, start on Aspirin, Coreg, Sprial CT scan to r/o pulmonary embolus

    Assess: Respiratory Distress secondary to CHF exacerbation. Rule out secondary to Pneumonia. Rule out pulmonary embolus

  2. #2
    Join Date
    Apr 2007

    Default 99221

    I agree, you don't have a comprehensive history or exam.

    Laura, CPC

  3. #3
    Join Date
    Apr 2007


    Can someone please give me the breakdown/explanation on how you got 99221 ? I would have billed the same way being there was not enough documentation to bill a comp exam/physical but i am having trouble finding a detailed exam as well. If you don't get at least 3 of 3 for an admit you can't bill at all correct ??? I am using the 97 guidelines and come up with 7 bullets for PE : 1 Vitals,2 HEENT, 3 NECK, 4 CV,5 Resp, 6 ABD, 7 CNS. For the ROS i got 3 bullets = 1 Resp : He denies chest pain,2 Cons fever, shaking chills, 3 Gastro: nausea or vomiting, diarrhea or abdominal pain.

    Thanks in advanced !!!
    Last edited by cpccoder2008; 07-21-2009 at 03:00 PM.

  4. #4
    Join Date
    Apr 2007


    On 97 it is not a detailed exam, you have to use 95 to reach it in this case.

    If this was one of mine, we only use 97 it is a hospital rule here, this would be sent in as a 99499. And we are getting them paid!!!!

    Laura, CPC

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