based on calculator, thats a tenuous level 5. seems level 4 is more appropriate.
I see plenty of patients with those symptoms too. Most of them are a level 4. The difference with this one is they were new within the last few months and have not been adequately worked up or diagnosed.
I disagree. Level 5 by medical problems, level 5 by data reviewed as there was independent interpretation of MRI, then review of multiple other data points, level 3 based on management.
With new guidelines, it can count in the time based coding. Not sure if it can be used for the MDM
Don’t forget to code therex -97110
Thanks.
Obesity, assuming it really is significant, contributes to both an additional problem being managed - a chronic disease with complications (increased severity of joint pain from the weight) - and increases risk of interventions, i.e. minor surgery with identified risk factors.
short answer - if you are already billing a level 4, obesity as a complicating factor really shouldnt be pushing it to a level 5.
Just because “someone else has it worse” doesn’t mean you can’t bill a level 5. Agree too many could trigger an audit, but they are still fairly rare for me.
Using regular language without hyperbole, why would a 300 pound pt on Xarelto bump you up to a level 5?
On its own, it wouldn’t. Since our treatments don’t typically meet the criteria for high risk of morbidity from treatment, it takes a severe exacerbation of symptoms or side effects, or life/limb threatening problem, plus lots of data, to bill a level 5. However, as I said above, obesity could bump a patient from level 3 to level 4 - minor surgery with identified risk factors, vs without.
Depends on your documentation. If you are appropriately documenting exactly how those contributory diagnoses affect your medical decision making for their pain issue then it is completely relevant
Letter from an insurance company few weeks ago saying I was “billing too many 04/14s” compared to my peers and now will be “monitoring my notes” or some bs. I had about this ratio.
They are threatening me with a “records review” if I don’t modify my future practice..why just seems annoying more than anything.
they run an algogrithm and try to find any outliers. if you keep it up, you will get more frequent reports. ive never had an actual audit, though.
I used to get these letters frequently and got an audit specifically looking at my 99214 visits.
Was it a lot of work for the audit?
Not so bad, but that is because I have a firm understanding of billing/coding and I know what they are looking for. My first audit was stressful and a lot of back and forth hiring attorneys. Now, I expect them as a matter of doing business
Also-if you do get a record review, hire your own coder/biller to go over uour notes and make sure you documented appropriately
Could you please name names re: this company or do we need to protect them?
United Healthcare
Figures.
Who is gonna send who to the ED then?
99205, for high complexity medical decision making - decision on whether to prescribe medications requiring intensive monitoring.
ESI bumps up the level not because of risk (which can be arguable), but rather the prescription medication used. Therefore it is moderate complexity
The problem list will count if you order/recommend it. The patient can defer medication/procedures or choose at a later Date
So let’s say a patient comes in post ESI or RFA and it worked.
Not sure how much you could bill for that, but for me unless it’s still hurting enough to need more referral or evaluation, that’s a 99212.
Can you look at yourself in the mirror and say “Yes that was some complicated medical decision making” with a straight face
Medical decision making or time decides the level
You may not personally believe this has any level of complexity for these decisions and likely it shouldn’t be difficult if you have any training. There is a set of definitions for what e/m coding is in terms of high, moderate, or low complexity.
Drop any/all diagnoses discussed/managed in the note. If more than 2 diagnoses and a Rx provided at the visit it is a 99214. If no Rx directly ordered during the visit then it will be 99212/3. If it takes you more than 20 minutes to prepare, talk, document then you have a 99213 based on time.
It’s missing complexity of data to be analyzed
The requirements are 2 of 3. Complexity of data is irrelevant
This. For sure a 99214. Although maybe a 99213 depending on wording of how Yoj document it. You have several problems addressed and a prescription. Also, could define treatment as “decision not to proceed to further injections based I response”, as the E and M guidelines are clear that a decision not to treat with a procedure or medication is the same medical complexity as doing a procedure or med.
I do the same, but I don't think I ever do a level 2. Even if they are doing fine, often I will briefly discuss an injection as a future option.
yes.
Minimal risk scenarios would be a health patient, nothing wrong, your physical exam, etc,,.
99213, based on LOS calculator...
I would disagree. Gaba is med management, would qualify as level 4. Deciding against further injections is level 4 risk. These plus the two diagnoses geta Yoj ti a 99214.
