# Code 99215 or 99354 (based on time)



## JesseL (Oct 19, 2014)

We have a child patient who need's keloid injections but every time she comes, a lot of time is spent struggling with her to do the injection.  She throws a tantrum and vomits every time but this time at least 45 minutes was spent with the patient doing this and telling the patient's mother she must bring her child early in the morning without eating breakfast because she throws up every time.  Problem focus history and exam since it's a returning patient for the same problem (keloid injections to finger)

Would I code this as 99215 just based on the 45 minutes spent with struggling with the patient and cleaning up her vomit.

Or 

Do I code it as 99212 + 99354 for prolonged service.  Do I include 11900 as well?

Thanks


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## mitchellde (Oct 19, 2014)

You cannot charge an office encounter for a planned procedure.  You can bill only the procedure, you can add a 22 modifier to the procedure and use addition dx code for any documented behavioral issue.


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## JesseL (Oct 19, 2014)

mitchellde said:


> You cannot charge an office encounter for a planned procedure.  You can bill only the procedure, you can add a 22 modifier to the procedure and use addition dx code for any documented behavioral issue.



Is there any codes that's not categorized under under dementia or mental disorder for her combative behavior?  I mean the kid freaks out at the sight of the needle (what kid doesn't) but I don't want to slap a label on her saying she's mental.


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## mitchellde (Oct 19, 2014)

Look under the 799 category you should find something there and those are symptom codes.


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## JesseL (Oct 20, 2014)

mitchellde said:


> Look under the 799 category you should find something there and those are symptom codes.



The 799 category is "Other ill-defined and unknown causes of morbidity and mortality" though.. are these for symptoms where the patient is dying?


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## mitchellde (Oct 20, 2014)

No morbidity is just incidence of disease or complicating factors.


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