99213 billing question

[linguistafeliz]

I know this is a weird question...

when I bill 99214s, I try to put all or at least most of the problems I address in the code. E.g. I will bill 99214 and in the problems that my EMR requires me to enter, I may put "hypertension" and "diabetes" and "back pain."

There are a lot of 99213s I see that I still see more than one problem (e.g. maybe someone had URI symptoms and hypertension that is well controlled). To save time I tend to only put one thing (e.g. "hypertension") Is that kosher in the billing/coding world?

Does any of this matter since I assume coders have to go through our notes anyway?

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[deleted87716]

I know this is a weird question...

when I bill 99214s, I try to put all or at least most of the problems I address in the code. E.g. I will bill 99214 and in the problems that my EMR requires me to enter, I may put "hypertension" and "diabetes" and "back pain."

There are a lot of 99213s I see that I still see more than one problem (e.g. maybe someone had URI symptoms and hypertension that is well controlled). To save time I tend to only put one thing (e.g. "hypertension") Is that kosher in the billing/coding world?

Does any of this matter since I assume coders have to go through our notes anyway?

You should always put all of the problems that you address in your note, and code appropriately. Anything less is leaving money on the table. You have to keep medical necessity in mind, however. You can't just "address" all of their chronic problems every time they come in for something acute. If somebody comes in for a URI and also happens to have HTN and their BP is normal, you shouldn't code for the HTN unless it becomes relevant somehow (e.g., they complain about med SE or something). If their BP is elevated, however, you should address it. That may or may not bump you from a 99213 to a 99214, depending on how you document.

 

[Ironheme]

If you address it, you write it. To undercode is actually considered fraud in addition to leaving money on the table. 3 stable problems --> 99214. URI + stable HTN to me, does not warrant 99214, as URI would be simple decision making, and then you only have one chronic problem. IF you did an extensive work up, or showed you thought about say CAP - pocket rx given if symptoms not improved for potential CAP, then that would be a 99214 even without the HTN. I've attached the quick and dirty reference I use for 99214's from FPM.

Medical decision making and necessity should drive your coding and visit. EHR/Epic can suggest what they want you to address for their perfect point system, but you're the doc - you decide what's important to address at the visit.

 

[deleted87716]

To undercode is actually considered fraud in addition to leaving money on the table.

Yeah, but you'll never get in trouble for that, as you're only defrauding yourself.

 

[KnuxNole]

To be honest, maybe I'm doing this wrong, but I feel like half of my visits can't meet a 99214, since they only have one or two chronic conditions. Maybe this subset is just healthier than what most of my colleagues see...??

 

[VA Hopeful Dr]

To be honest, maybe I'm doing this wrong, but I feel like half of my visits can't meet a 99214, since they only have one or two chronic conditions. Maybe this subset is just healthier than what most of my colleagues see...??

If that's true, you're right that 2 stable chronic conditions won't get you to a level 4. But, there is a good chance you're overlooking something.

If you counsel your hypertensive/hyperlipidemic patient on losing weight, code for overweight/obesity and you've got another chronic condition and now you're level 4. Same if you add anything about smoking or drinking.

Don't forget to include any "Oh by the way" stuff, even if super minor.

 

[FrustratedFamDoc]

To be honest, maybe I'm doing this wrong, but I feel like half of my visits can't meet a 99214, since they only have one or two chronic conditions. Maybe this subset is just healthier than what most of my colleagues see...??

Half?!? I've gotta get out of GA.

 

[deleted87716]

If that's true, you're right that 2 stable chronic conditions won't get you to a level 4. But, there is a good chance you're overlooking something.

If you counsel your hypertensive/hyperlipidemic patient on losing weight, code for overweight/obesity and you've got another chronic condition and now you're level 4. Same if you add anything about smoking or drinking.

Don't forget to include any "Oh by the way" stuff, even if super minor.

Definitely code obesity (or even overweight), smoking, any lab abnormalities, and any stuff they’re treating with OTC meds (e.g., SAR, GERD, DJD, etc.) This time of year, half the folks you see have colds. Code it, even if all you do is recommend OTC stuff. And be sure to code conditions being managed by specialists. It all factors into the complexity of your MDM, as well as HCC coding (which matters a lot when you have a P4P contract with a payer).

 

[Ironheme]

Same if you add anything about smoking or drinking.

Don't forget to include any "Oh by the way" stuff, even if super minor.

Generally need 3 chronic problems.
Or if you're dealing with 2 chronic or 1 new...or 1 new problem that requires work up could even be a 99214 depending on your decision making level.

There is an additional billing code you can add by the way for smoking cessation counseling in addition to 99214. It's an extra ~40$ iirc for Medicare/Medicaid. Depends on 3-10 minutes vs >10 minute counseling cessation. Iirc code was 99406 & 99407 respectively.

 

[Premed2500]

Hi all,

I am going into outpatient practice and wanted to ask what the best resources are to learn about billing? Ty

 

[VA Hopeful Dr]

Hi all,

I am going into outpatient practice and wanted to ask what the best resources are to learn about billing? Ty

http://www.drkney.com/pdfs/level4.pdf

 

[Premed2500]

http://www.drkney.com/pdfs/level4.pdf

Ty so much!!

 

[Freezeout]

I also include problems if I don’t necessarily address them, but they somehow factor into my decision making. Like back pain primary reason for the visit but they also have ckd and cad so I can’t use PO NSAIDs. Or URI but also is immunosuppresed because of their lupus meds. Like I’m not managing those problems in the scenario but they’re influencing my plan.

 

[deleted87716]

I also include problems if I don’t necessarily address them, but they somehow factor into my decision making. Like back pain primary reason for the visit but they also have ckd and cad so I can’t use PO NSAIDs. Or URI but also is immunosuppresed because of their lupus meds. Like I’m not managing those problems in the scenario but they’re influencing my plan.

Yep. That's how you get to 99214.

 

[Freezeout]

Generally need 3 chronic problems.
Or if you're dealing with 2 chronic or 1 new...or 1 new problem that requires work up could even be a 99214 depending on your decision making level.

There is an additional billing code you can add by the way for smoking cessation counseling in addition to 99214. It's an extra ~40$ iirc for Medicare/Medicaid. Depends on 3-10 minutes vs >10 minute counseling cessation. Iirc code was 99406 & 99407 respectively.

The thing to know on that code is it can only be billed twice a year, and you have to document how much time you spent. Also it’s first come first serve. So you, pulm and cards can’t be billing for it. Someone’s would be denied.