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Cpt code 99204

  1. Default Cpt code 99204
    Medical Coding Books
    I work for a orthopedic surgeon he wants to code a 99204.He uses a Single Organ Musculoskeletal exam sheet for the exam he dictates a full musculoskeletal examination was documented on our office form please see these forms for additional information. I am confused if that is enough the code states they need to do 10 organ systems. He is a specialist a Ortho Surgeon. Please Help confused Cora

  2. #2
    Columbia, MO
    It is possible using the 97 guidelines and the ortho body system but it must be documented for each bullet each defined area such as each extremity, neck, back, he cannot just say he did a complete review each individual point must be documented for each area.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    The 10 organ systems you are referring to sounds like the ROS requirement, not the exam requirement.

    In order to get a comprehensive history you are required to review 10 or more systems, no matter what exam you use.

    So here is the rub, for specialists like ortho especially, is it medically necessary for them to do this? I have been in rooms with multiple providers and watched them go back and forth on whether or not this is medically necessary.

    Medical necessity is a whole other issue though.

    Just be sure you are counting your elements where they belong. History and exam are completely different and not interchangeable.

    Laura, CPC, CPMA, CEMC

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