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Auditor got a 99213 out of this ???

  1. #1
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    Salt Lake North
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    637
    Cool Auditor got a 99213 out of this ???
    Exam Training Packages
    1. Repeat ultrasound shows resolution of the right lower extremity DVT.
    2. Nonetheless, the lymphedema is still present. I see no evedence of furher cellulitis. At this point I am hesitant to increase diuretics and will continue of furosemide 20mg in the morning and noon and the potassium. At this point I think there has been enough venous status and lymphatic change that this is going to be a permanent problem.
    3. INR today is 1.5. We will now increase his coumadine to 2.5 mg daily.

    Auditor got PF/EPF/Low

    Not sure if I see it, do you?

    Thanks !!

  2. #2
    Location
    Salt Lake North
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    637
    Cool
    Sorry, DX were DVT and lower extremity edema.

  3. #3
    Location
    Columbia, MO
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    12,560
    Default
    I get the same thing PF/EPF/Low. If using 95 Guidelines. 97 guidelines I have PF/PF/Low so a 99212

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Salt Lake North
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    637
    Cool
    Debra, how are you getting an EPF exam?

  5. Default
    Auditor got PF/EPF/Low ?????

    Huh? I am curious. Did the auditor give you the details how she counted this to get a 99213? Did she audit under 95 or 97? Does anyone have the time to count this out under 95 and 97 to show what counts for H/E/MDM?

    1. Repeat ultrasound shows resolution of the right lower extremity DVT.

    2. Nonetheless, the lymphedema is still present. I see no evedence of furher cellulitis. At this point I am hesitant to increase diuretics and will continue of furosemide 20mg in the morning and noon and the potassium. At this point I think there has been enough venous status and lymphatic change that this is going to be a permanent problem.

    3. INR today is 1.5. We will now increase his coumadine to 2.5 mg daily.

  6. #6
    Location
    Salt Lake North
    Posts
    637
    Default
    She did'nt give me the details (which really hurts) only the HX/EXAM/MDM for it. Makes it more difficult to comminicate with the docs on the results you know.

  7. #7
    Default Quick look at the record
    Quote Originally Posted by qcoder View Post
    She did'nt give me the details (which really hurts) only the HX/EXAM/MDM for it. Makes it more difficult to comminicate with the docs on the results you know.
    Seems like the auditor did a "quick look". Seems the auditor saw the increase in the medicine and decided it was a level 3.

    Being an auditor, i would check with the Doctor's MDM and then go with Hx and Ex. Was there more reports in the Hx the doctor reviewed, etc. But this doesn't appear to be a level 3. Hard to say without the complete record in front of me and i take your word the way you described and gave the info in full.

    Best,
    KL
    CCS, RHIT, CPC, CMBS

  8. Default
    I recently learned that when a provider changes or adds new medications for the patient, this would automatically raise the E/M visit level to at least a level three. This might explain their rationale.

  9. #9
    Location
    Columbia, MO
    Posts
    12,560
    Default
    if you use the 95 guidelines, we all agree history is focused
    you have the examination of the lymphedema plus the examination for cellulitis, this would make it expanded problem focused
    MDM
    I get limited under dx due to the dx plus the management option of the diuretics, then complexity I get minimal and risk is moderate so low
    As I said using 95 guidelines I can see a 99213, it is scant and not stellar but it is there. adding new meds BTW does NOT automatically raise the level to a 3. You must establish 2 out of three of the key components for an established patient, so you can add new meds and still have a level 2. If this were evaluted with 1997 guidelines then I get a 99212.
    If the auditor will not share the rationale with you I would go to her supervisor as that is completely uncalled for. They must share with you the guidelines they used and the rationale for the level.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Location
    Salt Lake North
    Posts
    637
    Default Thank you Debra!!
    Thanks for your explanation. It really helps.

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