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Thread: 99223

  1. #1
    Join Date
    Apr 2007

    Default 99223

    AAPC: Back to School
    I just have a few questions regarding the Trailblazer Initial Hospital Care Medical Review Results article Notice ID14580 regarding 99223.

    In the sample audited chart, they said they used shortness of breath for the HPI so it could not be used in the ROS. I have never heard that before and the 95 Guidelines state a problem, extended and complete ROS inquires about the system(s) directly related to the problem(s) identified in the HPI plus all additional body systems.

    On the MDM, they say prn Morphine. They give this an intermediate eval too. So, if it isn’t given, it apparently does not count even though should the patient in an hour have pain that warrants this, it will be given because it is prn. Maybe prn doesn’t count as high mdm because the patient has not arrived to that severity presently?

    Any thoughts? Thanks.

  2. #2
    Join Date
    Apr 2007
    Covington, LA


    Pamela, I haven't read the article that you are referring to and Trailblazers is not our local Medicare carrier, but in general you cannot use any information twice when choosing where the information goes when determining a level. If SOB is used in the HPI or as the chief complaint then you cannot re-use the same information in the ROS. You have to make a choice on which area you need that information and place it in one area. I hope this helps. Angie

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