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Self-limited/minor vs new problem no workup

  1. #1
    Question Self-limited/minor vs new problem no workup
    Medical Coding Books
    I'm looking for advice. Here is the scenario and my opinion.

    We have added a dermatologist to our staff, who beleives every new patient encounter should meet 99203. However, I believe that her patient who presents with CC spot on leg, diagnosed with benign nevus, no script needed, no follow up needed only meets criteria for 99202 based upon the MDM. Yes, this is a new problem to the physician, however, on the table of risk, I am coming up with only self limited/minor, no management options, or diagnostic procedures--overall meeting only straightforward decision making.

    Am I on the right track?

  2. #2
    Location
    Ellenville, New York
    Posts
    1,176
    Default Subject to interpretation, but....
    I would agree with you that a benign nevus would be a self-limiting or minor problem. That would make the MDM straightforward regardless of how many data points are documented (which you didn't mention in your scenario). Agree with you - 99202.

  3. #3
    Default
    Sorry, about the data points, in this case there were none.

    Thanks for the reply, I will be speaking with this physician and wanted some validation before our "documentation requirements" discussion.

  4. #4
    Default
    Quote Originally Posted by AR2728 View Post
    I'm looking for advice. Here is the scenario and my opinion.

    We have added a dermatologist to our staff, who beleives every new patient encounter should meet 99203. However, I believe that her patient who presents with CC spot on leg, diagnosed with benign nevus, no script needed, no follow up needed only meets criteria for 99202 based upon the MDM. Yes, this is a new problem to the physician, however, on the table of risk, I am coming up with only self limited/minor, no management options, or diagnostic procedures--overall meeting only straightforward decision making.

    Am I on the right track?
    How was it determined that it was benign nevus? Just by sight? If so, I agree with a SF MDM. If there had been some kind of pathology report from a previous encounter, then you can count reviewing it as 1 data point, but you're still only getting a SF MDM.

    Don't forget about coding based on time; if the physician documented time spent with the patient in counseling, and he documented the content of the counseling, and he spent at least half of the visit DOING the counseling, THEN you might be able to get to 99203. But it's still a stretch.

  5. #5
    Location
    Ellenville, New York
    Posts
    1,176
    Default
    Quote Originally Posted by btadlock1 View Post
    How was it determined that it was benign nevus? Just by sight? If so, I agree with a SF MDM. If there had been some kind of pathology report from a previous encounter, then you can count reviewing it as 1 data point, but you're still only getting a SF MDM.

    Don't forget about coding based on time; if the physician documented time spent with the patient in counseling, and he documented the content of the counseling, and he spent at least half of the visit DOING the counseling, THEN you might be able to get to 99203. But it's still a stretch.
    A very big stretch - almost like the old Stretch Armstrong dolls! Other than maybe an oncologist or mental health professional, I don't know of any type of physician that would see a brand new patient and not do SOME type of physical exam and also spent more than half the visit counseling. Unless there are some good examples out there....

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

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