Medicare Compliance & Reimbursement

Question: The physician started an established patient on a new drug. Two weeks later, the patient presented for her next appointment, and one of our non-physician practitioners (NPPs) evaluated the patient, taking blood pressure and other vitals. The NPP also asked the patient if she had experienced side effects since she started the new drug. The report indicates that the visit is specifically for checking how the patient is adjusting to the medication. What E/M code should I report for this encounter? Answer: Your code choice, as always, hangs on your documentation. If an NPP (ARNP or PA) provides care, you could have a 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) service, assuming your documentation supports that code. Or if the clinical staff (RN or CMA) under the direction of an NPP or MD provides the care, you may have a [...]