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Need Verification on New Pt Visit

  1. #11
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    Greeley, Colorado
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    Medical Coding Books
    Quote Originally Posted by jifnif View Post
    For the entire history component I had only a brief HPI. No ROS or PFSH. Sorry for the confusion.
    Then you simply have 99201 based in a problem focused history. I would not code to the established levels since those requirements are different and would get you to 99214 with a PF hx, Comp exam, and moderate MDM. That would be upcoding the visit.
    Lisa Bledsoe, CPC, CPMA

  2. #12
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    Problem Focused History does qualify for 99201. I think I was looking too hard when the answer was right there....

  3. #13
    Location
    Pottstown/Philadelphia
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    266
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    Thanks to everyone who responded. Now the question would be, how do you tell your QA that they are wrong? This is a new job. Anything that comes back from the payor as my error (even after it is checked by QA) is 20% off of my pay.

  4. Default
    WPS Medicare says that if you don't have enough documentation to support even a 99201, then you should code a 99499 and submit notes to them

  5. #15
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    Quote Originally Posted by jifnif View Post
    Thanks to everyone who responded. Now the question would be, how do you tell your QA that they are wrong? This is a new job. Anything that comes back from the payor as my error (even after it is checked by QA) is 20% off of my pay.
    Print out a copy of the 1997 E&M Guidelines and walk them through the documentation. You can't come up with anything other than 99201. You can use the New vs. Established patient diagragm in the CPT book to get you to the correct section... Good luck!
    Walker Bachman, CPC, CPPM

  6. #16
    Location
    Greeley, Colorado
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    Quote Originally Posted by 1071471 View Post
    Problem Focused History does qualify for 99201. I think I was looking too hard when the answer was right there....
    Happens to ALL of us!!
    Lisa Bledsoe, CPC, CPMA

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