Billing questions

[timisdaman]

What distribution of level 3 and 4 visits do you all bill for (new and follow up)?

Also, for a comprehensive physical, are you all going for 2 bullets from 9 organ systems, or all bullets from the musculoskeletal specialty exam (http://emuniversity.com/PDF/Specialty_Exam_Musculoskeletal.pdf)? In one of my clinics, there is no one taking vitals (and I certainly won't), so I don't think I'll be able to fulfill the requirements for the comprehensive specialty exam. I am in academics, by the way.

Thanks!

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[lobelsteve]

What distribution of level 3 and 4 visits do you all bill for (new and follow up)?

Also, for a comprehensive physical, are you all going for 2 bullets from 9 organ systems, or all bullets from the musculoskeletal specialty exam (http://emuniversity.com/PDF/Specialty_Exam_Musculoskeletal.pdf)? In one of my clinics, there is no one taking vitals (and I certainly won't), so I don't think I'll be able to fulfill the requirements for the comprehensive specialty exam. I am in academics, by the way.

Thanks!

Not taking Vital Signs is not being a doctor. We get temperature heart rate and blood pressure on everybody. If you don't have anybody to assist height weight and respiratory rate can also be used.

 

[PMR2008]

Respectfully disagree with Lobelsteve. I have a MSK clinic and I do not take vitals on my patients and have never needed to for a routine visit. On the other hand before injections patients get vitals. Also vitals are on standby if needed. The last 4 times I have gone to a specialist (derm, GI etc) for a check up they have not taken my vitals. Every time I go to my PCP they check my vitals, which I appreciate.

Level 3 needs a expanded problem focused exam and Level 4 needs a detailed exam.
Per the 97 Guideline you need 6 bullet points for the expanded problem focused and 12 for the detailed exam. I am attaching the 97 guideline for MSK exam. Example of expanded focused exam for a shoulder is
NAD, Appears stated age, pain with palpation right anterior shoulder at the greater tuberosity, ROM limited to 70 degrees in flexion and abduction due to pain, no laxity or dislocation noted, strength is 5/5 distally and limited proximally due to pain. No focal sensation loss noted in RUE.

Example of detailed exam for low back is
NAD, AOx3, slightly anxious mood
Antalgic gait pattern noted, pain with palpation diffusely around lumbar paraspinal muscles, ROM limited in flexion, side bending and extenison of spine due to pain, 5/5 strenght in b/l LE, no skin leasions or scars noted in lumbar spine (8), 2/4 bilateral achilles and patellar reflex, sensation intact to light touch in all lumbar dermatomes bilaterally. Normal coordination noted in bilateral LE. Normal pedal pulses.

These are just examples. My exams are more detailed (special tests, more info on strength and gait). Also you only need 2/3 key components even though I almost always make sure all 3 are in compliance.

 

[Agraphia]

Can you bill a level 3 (99233) for patients you team conference in inpatient?

Thanks!