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99215 ???

  1. #1
    Default 99215 ???
    Medical Coding Books
    I am reviewing some E/M coding and am stumped about these 2. Thoughts please.

    First case - 18 month old comes in one day and diagnosis is epistaxis and impetigo. Bactroban prescription is given. Returns very next day for WCC and cellulitis Lt thigh & Rt knee. A WCC is done with the following information:
    Nutritional history done
    Current meds - claritin
    NCSLV (no change since last visit - day before)
    Physical assessment: height, weight, head circ, chest circ, temperature, pulse, respirations
    Notations under exam: cellulitis lt thigh, r knee
    HBG 12/1
    Oral lead risk is negative
    Plan - 1 gm rocephin

    Physician wants this coded as a 99215

    Second case - 11 year old comes in for weight check and vomiting 4x's
    Notations read:
    Current meds - stool softeners
    Illness/Accident/ER/Hospitalization - none
    NCSLV 1 month ago
    CC: Loves to eat
    vomiting - how long - last night 4 times, no f/d
    weight/ pulse/ respirations taken
    parent states: sneaking soda/ sweet tea
    Expanded exam is done
    Dx = Morbid obesity, allergic rhinitis ETD
    35 minute counseling
    claritin otc


  2. Default
    In the first one, are you asking about the well child visit or the first visit? If well child, you would use well E&M 99392, and the cellulitis could be considered part of the well visit. If the provider documented enough to support the well visit and wants to charge a sick ov code as well, use a modifier and charge both.
    If you were referring to just the first sick visit, there is no way the nature of presenting problem would support a 99215. (even if there is enough documentation in the chart not.)

    The second one, it looks like provider is documenting time. With 35 minutes face to face, that would only be a 99214.

    Hope this helps!

  3. #3
    Thank you for the help.
    In the first scenario, I am referring to the 2nd well care visit. I'm not sure there is enough documentation to support both the wcc and the ov. I'm leaning towards the wcc.

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