# Need the opinions of My Fellow Coders



## AthensCoder (Feb 10, 2010)

I am taking online courses through the University of Phoenix and had an assignment due.  Please see below the questions and the attached answer key, (in seperate post)which I believe is incorrect.

1. Initial *consultation* is performed for a 78-year-old woman with unexplained weight loss, abdominal pain, and rectal bleeding. A comprehensive history and examination is performed.

2.   A 30-year-old patient presents complaining of flu-like symptoms characterized by unremitting cough, sinus pain, and thick nasal discharge. An examination reveals bronchitis and sinus infection. The patient is prescribed a 5-day course of Zithromax. 

3.   Established patient on Lithium presents for routine blood work to monitor therapeutic levels and kidney function. A nurse reviews the results and advises the patient that tests are normal, and no change in dosage is indicated.

4.    A 62-year-old diabetic female presents for check-up and dressing change of wound on left foot. An examination reveals the wound is healing. The nurse applied new dressing and patient will return for a check-up in one week. 

5.   A mother brings in her *6-month-old male child for a routine wellness *check. An examination reveals the child to be in good health and making adequate progress.


----------



## AthensCoder (Feb 10, 2010)

*Answer Key*

1. This is an office visit, for a new patient with a comprehensive history and physical exam, so the for this range from New Patient 99201–99205, being:
99201: problem focused history and PE
99202: expanded problem focused History and PE
99203: detailed history and PE 
99204: comprehensive history and PE, moderate medical decision making
99205: comprehensive history and PE, high medical decision making
The correct code will be 99205 

2. This is an office visit, new patient but the history and PE is expanded problem focused because the patient have 2 or more conditions but the treatment is straight forward that is why we have to use 99202.

3. This is an office visit, established patient. The codes for established patient range from 99211-99215.
99211: office visit that may not require the presence of a physician
99212: problem focused
99213: expanded problem focused
99214: detailed history
99215: comprehensive history.
the correct code for this case will be 99211 because the nurse was the one who took care of the patient

4. this will be an office visit, established patient (check up), for a examination of healing wound, this will be code 99214

5. this is an established patient that comes for a complete checkup so we will have to use code 99215 that contains a comprehensive history and physical exam.

Is this right?  #1 say it is a consultation and #5 is a WCC


----------



## LLovett (Feb 11, 2010)

Are those the full questions? If so you can not correctly level based on that info.

1. Initial consultation is performed for a 78-year-old woman with unexplained weight loss, abdominal pain, and rectal bleeding. A comprehensive history and examination is performed. Without knowing what was done testing/treatment wise you are stuck with moderate MDM on this so it would be a 99204.

2. A 30-year-old patient presents complaining of flu-like symptoms characterized by unremitting cough, sinus pain, and thick nasal discharge. An examination reveals bronchitis and sinus infection. The patient is prescribed a 5-day course of Zithromax. There is no way to level based on this info. This is not straightforward MDM, it is moderate.

3. Established patient on Lithium presents for routine blood work to monitor therapeutic levels and kidney function. A nurse reviews the results and advises the patient that tests are normal, and no change in dosage is indicated. Again, no way to level without documentation. Based on this it could just be a 36415 for all I know.

4. A 62-year-old diabetic female presents for check-up and dressing change of wound on left foot. An examination reveals the wound is healing. The nurse applied new dressing and patient will return for a check-up in one week. Again, no way to level anything. I see no provider involvement and this is an established problem getting better, can't support moderate MDM based on this.

5. A mother brings in her 6-month-old male child for a routine wellness check. An examination reveals the child to be in good health and making adequate progress. This should be either 99381 or 99391 most likely but really not enough to make that call for sure.

Laura, CPC, CPMA, CEMC


----------



## cheermom68 (Feb 11, 2010)

*questions*

I agree.  If this is a coding class, that is alarming.  Way too little information, and the answers based on the information are far from correct.


----------



## apotteiger (Feb 11, 2010)

*Ccs, ccs-p, cpc, cbcs, cmaa, chi*

1. Initial consultation is performed for a 78-year-old woman with unexplained weight loss, abdominal pain, and rectal bleeding. A comprehensive history and examination is performed.  
*This would require a consultation code, not an office-visit code.*

2. A 30-year-old patient presents complaining of flu-like symptoms characterized by unremitting cough, sinus pain, and thick nasal discharge. An examination reveals bronchitis and sinus infection. The patient is prescribed a 5-day course of Zithromax. 
*Unable to assign a code; no documentation of patient status (new or established)*
3. Established patient on Lithium presents for routine blood work to monitor therapeutic levels and kidney function. A nurse reviews the results and advises the patient that tests are normal, and no change in dosage is indicated.
* If an established patient sees only a nurse, the only code that can be assigned is a 99211; however, a nurse should not be advising a patient on their lab results unless the nurse is a nurse practitioner.*

4. A 62-year-old diabetic female presents for check-up and dressing change of wound on left foot. An examination reveals the wound is healing. The nurse applied new dressing and patient will return for a check-up in one week. 
*It is not well documented who performed the examination.  If the patient saw only the nurse for the dressing change, this would be coded as a 99211.  See the clinical Examples in appendix C which allow a 99211 be coded if the nurse performs a dressing change for an established patient.* 

5. A mother brings in her 6-month-old male child for a routine wellness check. An examination reveals the child to be in good health and making adequate progress.
*This is a well-child check, but no documentation of new or established patient status.*


----------



## fredahollis (Feb 11, 2010)

#1-per 2010 CPT, Medicare doesn't recognize Consultation codes. Since the patient is 78, are we to make the leap that we are billing Medicare? More than likely. So the 99205 would be correct. The nature of her presenting problem (unexplained weight loss, abdominal pain, and rectal bleeding) is high MDM.  Multiple DX, tests, and high risk are present.  Remember we only need 2 out of 3 for MDM.

#2- They are assuming that we know that this is a new patient. Not enough  info to code new vs established.

#3- 99211 - This is clearly an incident-to service. The nurse is following the guidelines set forth by the physician. I agree with 99211.

#4- i agree with 99214..nature of presenting problem..the physician performed the examination.

#5- "routine check up" I would code this from the preventive codes...yes to well-child care


----------



## cleanclaims (Feb 11, 2010)

I think that you aren't explaining the intent on this portion of your training.  I have taught for a career college so I am going back to my memory on how this part of the training goes, so you can tell me if I am wrong, but I believe that you are in the beginning portion of your E/M training and they are trying to get you to understand the difference between the code ranges of E/M, such as:
9920X is a new patient section 
9921X is an established patient etc.  

They specifically do not give you too much information because it will stress you out when you are first starting to learn E/M but they give you a little bit of info that you don't need to see how you do with pulling out the important information that is needed to answer the question.  (They did get the well visit code wrong, however)

Please confirm if I am stating your learning process correctly.


----------



## LLovett (Feb 11, 2010)

The alarming thing is people are answering these questions when there is clearly not enough information.

I can see blondemoments point but if that is the case why are they giving the option of all the different levels in 1 code set instead of 9920X, 9921X, 9924X, etc?

Unless there is something wrong with my computer and I am not seeing all the posted info these questions are not answerable with any degree of accuracy or compliance.

No wonder people complain they can't pass the exam after schooling if this is the way they are taught. That is probably off base but its been a long day...

Just my opinion not trying to offend anyone,

Laura, CPC, CPMA, CEMC


----------



## cheermom68 (Feb 12, 2010)

*test*

Laura,
I don't think what you said was offensive at all.  I completely agree with you.  Clearly not enough info to answer any of the questions accurately.  I also think that even if it is early in their education, that doesn't excuse giving incorrect guidance.  They need to learn correctly from the beginning or it will just become more confusing as they advance.


----------



## AthensCoder (Feb 12, 2010)

*Thank You!  Now I know I am Not Crazy*

This is an assignment I had for a required class I am taking towards earning my Associates degree in Healthcare Administration ( I am not instructing/teaching it). 

 I am a certified coder and submitted my asnwers based on my training and knowledge, and the instructor is arguing with me, and presented me with the above answer key (which is totally wrong).  

What is even worse is that the instructor is an MD and supposedly a Coding Specialist. Also, oneof the scenarios did not list whether the patient was an established or new patient and he told the class that since it does not say establised or new than it is a new patient.  Correct me if I am wrong, but if it doesn't say and since there is no documentation to review, such as patient account information, shouldn't this be billed as an established patient.  Lastly we as coders are taught "never to assume".


----------



## AthensCoder (Feb 12, 2010)

So, what are people supposed to do that have coding knowledge.  Just sit back and let these instructors teach everyone else wrong.  That doesn't seem right to me.  Like Laura said, no wonder these coders aren't passing their exams.  Furthermore, it is even more I don't know what is worse, teaching these students wrong, or knowing that the teacher is a doctor and "coding specialist", is willing to teach this way knowing that the information being given is wrong.


----------



## cmcgarry (Feb 19, 2010)

Wow!  I teach coding at our local community college, and would never give my students questions with so little information, even when they first start out.  Our main text for the beginners is Carol Buck's Step by Step, and she gives much more information so that E/M can be chosen correctly.  The questions you posted are very similar to ones that are in a coding workbook I use for supplemental questions; but since the E/M questions don't give enough information, I never use them.  

Too many times non-certified coders teach the coding classes at different colleges.  Luckily, my lcc insists that to teach coding, you must be a certified coder!

Good luck.


----------

