Page 2 of 2 FirstFirst 12
Results 11 to 18 of 18

Thread: Selection of E/M

  1. #11
    Join Date
    Apr 2007
    Posts
    16

    Default

    Promo: Code Books
    I understand the argument it's just as a patient I think it stinks. I've taken my children in for ear infections just to get the amoxicillan (sp) that they'd taken many times over the years and if I would have been charge $182 for the visit I would have choked. All you need HPI "Her right ear has been hurting 2 days and we've put heat on it but no help. No fever. ROS "No rash, no cough. PMH: Gets 2-3 ear infections a year" New problem + RX=99214 What's not fair is the providers that give antibiotic for EVERY ear pain, sore throat or bug bite or pain meds for every back ache get a 99214 and then other providers that recommend over the counter or heat/ice get a 99213. The providers have picked up on this so guess what? Scripts are written 99% of the time. As for chronics...we've been told Vit D def and obesity can be counted as chronic so basically every person could in reality have 3 chronic dx's. I'm healthy but I have HTN but I'm also overweight and since I live in Oregon I have vit D deff (as do 75% of us in OR) Dr mentions all these and gives HTN med and 99214. I get it... I just don't like it.

  2. #12
    Join Date
    Apr 2007
    Location
    Fort Wayne In
    Posts
    72

    Question E/M

    OK correct me if wrong...2nd guessing myself....E/M's include seven components, six of which determine the level of E/M. The six are hx, exam, mdm, nature of presenting problem, counseling, coordination of care and nature of presenting problem...


  3. #13
    Join Date
    Apr 2007
    Location
    Daytona Beach, FL
    Posts
    722

    Default

    Quote Originally Posted by Bobby A View Post
    OK correct me if wrong...2nd guessing myself....E/M's include seven components, six of which determine the level of E/M. The six are hx, exam, mdm, nature of presenting problem, counseling, coordination of care and nature of presenting problem...

    There are 7 components, yes, but the History, Exam and MDM are the Required Key Elements for code selection. The others are considered contributory factors and are not needed for you code the level. Counseling can be used if you intend to bill your level based on time - the doctor must document the time he spent counseling the patient and this time must be at least 50% of usual time for the level chosen. The doc must also document the content and support for this counseling.

    Hope this helps.
    Jodi Dibble, CPC

  4. #14
    Join Date
    Apr 2007
    Location
    Daytona Beach, FL
    Posts
    722

    Default

    Quote Originally Posted by pnwcoder View Post
    I understand the argument it's just as a patient I think it stinks. I've taken my children in for ear infections just to get the amoxicillan (sp) that they'd taken many times over the years and if I would have been charge $182 for the visit I would have choked. All you need HPI "Her right ear has been hurting 2 days and we've put heat on it but no help. No fever. ROS "No rash, no cough. PMH: Gets 2-3 ear infections a year" New problem + RX=99214 What's not fair is the providers that give antibiotic for EVERY ear pain, sore throat or bug bite or pain meds for every back ache get a 99214 and then other providers that recommend over the counter or heat/ice get a 99213. The providers have picked up on this so guess what? Scripts are written 99% of the time. As for chronics...we've been told Vit D def and obesity can be counted as chronic so basically every person could in reality have 3 chronic dx's. I'm healthy but I have HTN but I'm also overweight and since I live in Oregon I have vit D deff (as do 75% of us in OR) Dr mentions all these and gives HTN med and 99214. I get it... I just don't like it.
    This is a mixed issue - as a patient you feel ripped off, but as a coder, you know it is correct. I know some doctors understand that giving the RX and such will raise the level, but also in defense of the doctors, I work at an Urgent Care and most of our patients are upset and sometimes quite verbally abusive if the don't get an RX or something for bug bites, simple soar throats, back ache, etc. They feel they are paying alot of money and if they don't get an antibiotic, whether right or wrong, they are not getting their money's worth. So, some of our doctors appease the patients with an RX, however we have one doctor who will not give out RX's unless clinically needed - and boy you should hear the names he gets called by these patients! And the fuss they make at check out when they have to pay "for nothing". I guess it depends on what side of the fence you are on!!
    Jodi Dibble, CPC

  5. #15

    Default additional work up

    Hi folks, i love seeing all the opinions going around about leveling out an E/M. doesn't it make coding fun? hehe

    anyways...i had a question regarding "additional workup"
    what does this actually mean? like what is considered additional workup? dont the points in amt & complexity data include this workup?

    thanks~ any feedback would be awesome!

  6. #16
    Join Date
    Apr 2007
    Posts
    26

    Default

    when you are auditing, the HPI , ROS and the physical exam must be directly related to the presenting problem, if they are not, you cannot count them as part of the EM coding selection. This rule is an upcoding prevention.

  7. #17
    Join Date
    Apr 2007
    Location
    Daytona Beach, FL
    Posts
    722

    Default

    Quote Originally Posted by mizzmaryb View Post
    Hi folks, i love seeing all the opinions going around about leveling out an E/M. doesn't it make coding fun? hehe

    anyways...i had a question regarding "additional workup"
    what does this actually mean? like what is considered additional workup? dont the points in amt & complexity data include this workup?

    thanks~ any feedback would be awesome!
    Hi Mizzmaryb - additional workup means that the doctor is sending the patient for further tests, etc. that will be done elsewhere (i.e. CAT scans, MRI's) and his decision maybe pending these results. If he does the testing at the same time of the visit (i.e. rapid streps, unrine dips), this does not qualify for additional workup.
    Jodi Dibble, CPC

  8. #18

    Default

    thanks jdibble!

Page 2 of 2 FirstFirst 12

Similar Threads

  1. Diagnosis selection
    By maine4me in forum Diagnosis Coding
    Replies: 2
    Last Post: 04-07-2015, 10:36 AM
  2. Catheter selection for..
    By camsgram in forum Interventional Radiology
    Replies: 1
    Last Post: 02-13-2013, 10:07 AM
  3. EHR selection
    By LizM in forum EMR/EHR Systems
    Replies: 7
    Last Post: 06-22-2012, 02:33 PM
  4. Code selection help!!!
    By Love Coding! in forum E/M
    Replies: 12
    Last Post: 12-28-2010, 08:33 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.