# Accutane follow up patients 99214?



## JesseL (Apr 20, 2015)

Most of the time i think f/u accutane patients are usually about 99213 even with minor side effects.  I'm searchin through the web and found the example below would justify 99214, but I don't think I agree with it, atleast the MDM part.

The MDM part, I see 1 point for review of labs, 2 points for presenting problems, and moderate risks. = 99213.

What does everyone else think?  

Also, if a problem is not responding to treatment or "intermittent" is that considered "worsening"?

1. HPI factors
a. location ? face
b. duration ? three month flare
c. signs and symptoms ?- generalized redness, multiple pustular lesions on forehead and chin, three large cysts on preauricular region bilaterally
d. severity ? moderate

2. *ROS* ? no headaches, no indication of depression or mood swing, sleeps well, no changes in appetite or weight, has dryness in lips and eyes, no stomach pain, trouble swallowing, heartburn, diarrhea or changes in urine color. No vision or eye problem.

3. *Social history* ? works out of doors in nursery but trying to minimize sun exposure. Sexually active. Uses Ortho BCP and condoms during sex.
(May be completed by staff)


4. *Exam* showed multiple, large cystic lesions on lt. and rt. preauricular region. Face is red with inflammation and pustular lesions.
Lips are cracked and dry

Eyes seem normal
Weight 156 lbs.
BP: 135/80

5. Medical decision-making
a. Reviewed lipids report ? WNL
b. DX: severe recalcitrant nodular cystic acne
c. RX: pregnancy test ordered

Accutane XX mg. BID #30

e. Continue with BCP and condoms

The facts that this visit represents one chronic illness with side effects of treatment with multiple treatment options, diagnostic tests were ordered and reviewed, and the risk was high due to the nature of the prescription drug make this visit a viable use of CPT code 99214.

http://dermatologytimes.modernmedic...isits-may-i-bill-99214?id=&sk=&date=&pageID=2


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## CatchTheWind (Apr 21, 2015)

I also get a low MDM and a 99213 overall.

Incidentally, I believe the author is confused about what "signs and symptoms" means.  It is actually "associated signs and symptoms," which means other problems that are associated with the CC.  Thus "generalized redness, multiple pustular lesions..." are "quality," since they describe the CC. The only "associated signs and symptoms" I found was the "cracked lips" in the exam.


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