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Coding for Accutane/Acne patients established

  1. Smile Coding for Accutane/Acne patients established
    Medical Coding Books
    Hi out there, I need a guide to show me how I should code this visit.

    Established pt comes in for his monthly acne follow up being treated with Accutane. I have a P.A. that I work with that insists that these patients should be coded as a level 4 (99214) every time they are seen. I disagree,
    in regards to E & M and medical decision making, I say this should be coded as a 99212, here is my reasoning...

    A - Amount of diagnosis or treatment options = 1 established problem stable
    B - Level of Risk = moderate for prescription drug mgmt.
    C - Amount of data to be reviewed = 1 for labs reviewed

    Final result for complexity
    A - minimal
    B - moderate
    C - minimal
    ___________
    99212 - 2 of three meet

    Is this correct?

    Thank you

    dscoder74

  2. Default
    Hello, We do bill 99214 or 99213. Accutane is a high risk medication (V58.69), we are evaluating the acne and the medication at each visit.

  3. Default
    Hi Linda,

    I am curious to find out, when you use the E/M evaluation sheet under complexity..

    A - Number of diagnosis or treatment options
    answer - 1 if the acne is stable and improving and it is documented as such

    B - Risk of complications and/or Morbidity or mortality
    answer - High - due to drug therapy requiring intensive monitoring for toxicity

    C - Amount and/or data to be reviewed
    answer - 1 review and/or order of clinical lab tests

    Line them up 2 of three or middle and you get 99212. Am I missing something?

    Thanks!


    dscoder74

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I agree with dscoder. Although I know many providers who feel that they are providing a level 4 visit because accutane is a high risk med, but if all is stable it really shouldn't be a 99214.

  5. Wink Accutane followup
    Quote Originally Posted by Lisa Curtis View Post
    I agree with dscoder. Although I know many providers who feel that they are providing a level 4 visit because accutane is a high risk med, but if all is stable it really shouldn't be a 99214.
    Hi Lisa,

    Thanks for the reassurance!

    dscoder74

  6. Default
    Sorry took so long for me to reply. I agree to disagree, especially with Accutane. We do a thorough ROS, PFSH and PHI on the condition and the medication at each visit. If there is a side effect we may end up coding 99214. Generally for the amount of work the physician performs at each visit we bill a 99213 at least.
    We order and review labs, prenancy test (if appropriate), rx for accutane (high risk)and continue with contraception, rtn appt documented

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default 99212
    Based on the documentation provided (as per dscoder74's first post) I get a 99212.

    If your physician(s) document(s) more, lspray, then you could legitimately get level 99213 or 99214.

    I agree with dscoder and Lisa Curtis for this case.

    F Tessa Bartels, CPC, CPC-E/M

  8. #8
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I agree with dscoder, Lisa and Tessa too on this one - with the level 2... not much to go on to support anything higher.
    {that's my opinion}
    Donna, CPC, CPC-H

  9. Wink
    Quote Originally Posted by dmaec View Post
    I agree with dscoder, Lisa and Tessa too on this one - with the level 2... not much to go on to support anything higher.
    {that's my opinion}

    Thanks Ladies!

    dscoder74

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