# 99231,99232,99233



## dentfam (Apr 29, 2009)

Ok....I'm having difficulty with these.
My understanding is this:
231-patient is stable, recovering and/or improving
232-responding inadequately to therapy or has developed a minor complication
233-unstable or significant new problem and/or complication
I have been doing the Hospitalist billing for over a year now and our projections were: 11% 99231, 66% 99232, and 22% 99233
I'm finding that I think a lot of what is coded a 232 should be a 231
Do you guys agree with this based on your experience?
Maybe I'm missing something


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## FTessaBartels (Apr 29, 2009)

*Table of risk vs documentation*

Well, you've got a good start by focusing on the presenting problem to help identify where you fall on the table of risk. But that's only one component of MDM, which is only one of the key elements for determining your level of service. 

I find it interesting that you'd expect 88% of your subsequent hospital visits to show inadequate response up to and including major complications. But that's a hazard of focusing on just the presenting problem for the table of risk. 

You say that much of what is coded as 99232 should really be 99231. On what do you base that? Look at where your documentation is failing to meet 99232 standard and see if you find a pattern. 

I hope that helps.

F Tessa Bartels, CPC, CEMC


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## dentfam (Apr 29, 2009)

*99231,99232,99233 continued*

A lot of the documentation looks like this:

*Subjective*: The patient is feeling better today. She was working pretty meaningfully with physical therapy up and about in the hallway today.

*Objective*:  Temp 97.8, BP 106/61, heart rate 90, resp 24, oxygen sat 92% on 2 liters. Is and Os to date 120 in and 1420 out. Diffuse expiratory wheezing. No jugular venous distention.  Cardiac exam, regular rate and rhythm. Normal S1 and S2. Abdomen is nontender, nondistended with no organomegaly. There is continued 1+ lower extremity edema.

*Lab Studies*:  Two subsequent troponin I which are less than 0.04

*Impression/Plan*:  53 yr old woman with developmental delay presenting with issue of hypoxic respiratory failure.  This is likely attributable to chronic obstructive pulmonary disease with cor pulmonale.  She is now on steroids, oxygen, and brochodilator therapy.  I doubt that there is any contribution from heart failure as there is no evidence that she suffers from cardiac ischemia at this point.

The patient is on numerous medications which can predispose her to weight gain.  She does carry a diagnosis of seizure disorder maintained on Depakote.  Additionally, she is on Seroquel and now prednisone, all of which can increase her weight.  This is obviously counterproductive given her breathing difficulties as well as diabetes.  This issue can be taken up further on an outpatient basis with her primary care physician.

_*What do you think?*_


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## FTessaBartels (Apr 29, 2009)

*99232*

You have an EPF exam per 1995 guidelines and Moderate MDM.

I'd really like to see a chief complaint - even if just "F/U resp failure"

But this meets the criterion (2 out of 3 key elements) for 99232.

F Tessa Bartels, CPC, CEMC


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## dentfam (Apr 30, 2009)

Thanks for your input.  I think I was just caught up in the "stable and getting better" phase and was being too cautious.


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