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Thread: no exam consult only

  1. #1

    Default no exam consult only

    AAPC: Back to School
    i have a physician that does the HPI, ROS under the exam he puts consult only 20 mins can I bill the 99213?

  2. #2
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    I'ts hard to say without seeing a copy of the note. Is there documentation of MDM? What level HPI/ROS is audited? Did the physician document that >50% of the 20" was in counseling and coordination of care?

    I think we'd need more info to give you a straight answer. Pam
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    No exam - not billable. I have spoken to several compliance auditors and read several published resources, Trailblazer, Edgeblast, Dec 2000/Orthopedic Coding Alert, etc. that clearly document that documenting time does not negate the need for the physician to complete all 3 of the elements required by CPT descriptions. Time can be a controlling factor, only.

    If the PE is missing you use the 99499 E/M unlisted code.

  4. #4


    the HPI is expanded problem focused, the ROS is detailed. Referred out to orthopedic surgeon. It was a consult for results of an MRI not lab.

  5. #5


    Total time face to face consult 20 minutes

  6. #6


    Thanks mworcester I have a dr wanting to argue with me on this making sure that i wasn't missing something.

  7. #7
    Join Date
    Apr 2007
    Carmel, New York

    Default Another thought

    The doctor doesn't document ANY type of exam, not even an observation of "appears well", or such that can be counted under constitutional? Even with something that minimal, it could be an exam element, therefore resulting in all three elements being documented. Then, if all the requirements are met for time-based code assignment, you could go forward?

    I haven't seen a note without at least one constitutional element documented. Seems that much would be present....


    2016 Secretary
    Ellenville, NY Local Chapter

  8. #8


    Hard headed PA under exam he has No exam consultation only All I can do is use the 99211. I try to explain when he does that he is working for free

  9. #9
    Join Date
    Apr 2007
    Columbia, MO


    Quote Originally Posted by sharonglaze View Post
    i have a physician that does the HPI, ROS under the exam he puts consult only 20 mins can I bill the 99213?
    I agree it is hard to say without the note. But if it is an established patient he does only need to meet or exceed 2 out of the three key criteria. So it is possible that this could be a 99213.

    Debra A. Mitchell, MSPH, CPC-H

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