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Acute Mastitis

  1. #1
    Question Acute Mastitis
    Medical Coding Books
    I'm not unltra-familiar w/OBGYN, so please bear with my ignorance...

    I'm trying to audit a chart for a post-partum problem E/M. The patient presented with acute mastitis. I've got an EPF History, Detailed Exam, and Moderate MDM documented. The provider had picked 99213 for the visit.

    Is acute mastitis a severe enough problem to warrant a 99214?

    If I could change anything about the CPT book, I'd put a LOT more clinical examples in it. Thanks for the input!

  2. #2
    Default
    Hi Brandi,

    If you counted out a detailed exam and moderate, it qualifies a 99214.
    I would think it is possible to reach this level, especially if medication is prescribed.

    Have a great day

    Barbara
    The Oracle

  3. #3
    Default
    Quote Originally Posted by MJ4ever View Post
    Hi Brandi,

    If you counted out a detailed exam and moderate, it qualifies a 99214.
    I would think it is possible to reach this level, especially if medication is prescribed.

    Have a great day

    Barbara
    Medication was prescribed - antibiotics and painkillers, as well as special instructions on self-care. Honestly, the doctor was 1 HPI element away from having a comprehensive history, so I think the notes qualify for a solid 99214, but I just wanted to be sure that mastitis is a somewhat serious ailment that wouldn't have resolved without intervention, before telling the doctor that she shorted herself on payment. From what I remember hearing about it, I didn't think it was a trivial problem, but like I said before - I'm not too keen on OBGYN issues...

    I appreciate it!

  4. Default Acute mastitis
    I would agree with the doctor and bill level of service 99213. The problem is acute; however no additional studies are ordered and the risk level is low at this time because there are no complications.

    I agree with you more examples in the CPT section of E/M would really help. I am really trying to understand E/M coding so I am looking forward to reading the advice of additional experienced E/M coders to help with this one.

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