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What do you think?

  1. #1
    Default What do you think?
    Medical Coding Books
    I code for a clinic that has approximately 15 providers. We are currently having a debate about an issue that is occurring. I'm curious to see what others here think. This is the brief scenario:

    18 yr old female presents with cough, headache, congestion, and sore throat. A throat culture is performed, with a negative result.

    Based on this information, the following occurs:

    1. Dr. Jones see the patient and diagnoses her with an upper respiratory infection. He prescribes Robitusin, acetaminophen, mucinex and Cepacol throat lozenges for the patient's symptoms.

    2. Dr. Smith sees the patient and diagnoses her with an upper respiratory infection and acute pharyngitis. He prescribes Robitusin, acetaminophen and mucinex for the URI and azithromycin for the acute pharyngitis.

    3. Dr. Wilson sees the patient and diagnoses her with an upper respiratory infection and a headache. He prescribes Robitusin, mucinex and Cepacol throat lozenges for the URI and acetaminophen for the headache.

    What would you code for each of these doctors and why? Thanks for any responses.

  2. Default Cpc
    1. New vs Established. Est:99213
    2. New vs Established. Est:99214 MDM medication management
    3. New vs Established. Est:99213

  3. #3
    Columbia, MO
    Quote Originally Posted by lilahalverson View Post
    1. New vs Established. Est:99213
    2. New vs Established. Est:99214 MDM medication management
    3. New vs Established. Est:99213
    I am curious as to how you get those visit levels with only the information provide. If this is all that is available I am not seeing these visit levels at all. Can you please provide your analysis and how you arrived at these levels?

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    I'm sorry I've confused everyone. I thought since I posted this under "diagnosis coding" that everyone would know that's what I was referring to when I asked how you'd code these scenarios (E&M coding is a whole other issue!!!). Let me explain better. In coding, we know we're not supposed to code signs or symptoms if a definitive diagnosis is made, unless it's something out of the ordinary. If you google "URI symptoms", every site I've read states that a headache and a sore throat (aka, pharyngitis) are signs of a URI. HOWEVER, we're now being told that even if a provider gives a definitive diagnosis, if he/she specifically states they treated a sign/symptom, then we are to code that also. If you notice in the three scenarios I gave (all of which occur regularly at my clinic), both 1 and 3 have the exact same medications, but doctor #3 specifically stated the acetaminophen was for the headache. If a fourth doctor had seen this patient and diagnosed URI, and had specifically stated "Robitusin for the cough, mucinex for the congestion, acetaminophen for the headache and azithromycin and throat lozenges for the pharyngitis", would you then code all five diagnoses? My question then becomes, why even give a definitive diagnosis? Thoughts?

  5. #5
    Appendix 1, Section I.B.6 of our coding guidelines states "Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider."

    I stress the importance of "related" in this guideline. In this scenerio, the headache and sore throat are related to the URI and therefore should not be coded seperately. Even when meds are specifically assigned to each s/s, the "definitive diagnosis" of URI has been established. Only code the URI.

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