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Pediatric Expert

  1. #1
    Default Pediatric Expert
    Medical Coding Books
    Seeking guidance, Does this sound right. Auditing a physicians notes. The note reads to me, a 12yr old with new prob. Pharyngitis. No HPI, but we have Exam on TM. Documented with some detail. And lungs, also documented with some detail. With a prescription of Keflex. Does this qualify for a level four. Keep in mind this is an Establish patient.

    So we got: Establish Patient
    2 detailed body areas examined
    New Prob
    Prescription Drug given.

    Using the 1995 guidelines, do we come up with a level four.
    Need input.

    Daniel
    CPC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Medical Necessity rules
    I would not call pharyngitis is "new problem" so much as I'd term is "one self-limited or minor problem." So, despite the Rx, I would classify this as at best a 99213 visit.
    Tessa

  3. #3
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    I do agree with Tessa.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4
    Default
    Quote Originally Posted by FTessaBartels View Post
    I would not call pharyngitis is "new problem" so much as I'd term is "one self-limited or minor problem." So, despite the Rx, I would classify this as at best a 99213 visit.
    Tessa
    I too agree with Tessa, I think this is one of those scenerios where Medical necessity could come into play....

    I'd only give this a level 3.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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