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Thread: exam deferrred question

  1. #1
    Join Date
    Apr 2007
    Idaho Falls, Idaho

    Question exam deferrred question

    AAPC: Back to School
    I have a progress note I'm auditing for correct coding, that most of the exam was deferred because the pt was severely mentally handicapped and was frightened at the time of exam. The physician did a detailed history, the MDM was low, and there was a portion of the exam that was completed (vitals, general apperance and judgement/insight). How would I code this new pt visit? 99201 because we only got a problem focused exam?

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default This is where counseling time is important

    You state the patient was "severelly mentally handicapped and frightened."
    I can only assume that there was a family member or other caregiver - someone responsible for medical decision making - along with the patient on this visit.

    Here is where your physician should have documented time spent face-to-face with patient and family member, discussing condition and plan of treatment.

    You would need: TOTAL face-to-face time spent with patient; amount of that time (must be > 50%) spent in counseling/coordination of care; a summary of the counseling/coordination of care.

    Then the visit could be coded based entirely on time.
    10 minutes = 99201
    20 minutes = 99202
    30 minutes = 99203
    45 minutes = 99204
    60 minutes = 99205

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007


    You have to be careful though, even though time is the basis it still has to be medically necessary.

    This is something I struggle with on some of my providers. Even though you spent 60 minutes chasing a kid around the exam table trying to talk them into letting you look at thier ears, you don't get to bill a 99215.

    The problem is how do you determine what is medically necessary when time is the basis? I have asked this question and no one has been able to give me a clear cut answer. All WPSMedicare would say is it has to be "medically necessary". She did state that if the same problem could be handled in lesser time in a different patient it probably isn't justified to bill the higher level. But that is about is clear as she would get.

    As to your level of service, if time wasn't documented you would have to use what you have and it would be a 99201.

    Laura, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Idaho Falls, Idaho


    Thank you so much! That's what I figured, but I just wanted to make sure!

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