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Otolaryngology Coding Alert

These Patient Profiles Signal 99215 Territory

Published on Wed Feb 02, 2005

Look for high-level visit documentation with cancer/neuroma patients

To avoid undercoding or overcoding level-five established patient office visits, consider using 99215 when a patient has a complicated history and/or requires a complicated exam.

Not every established patient visit warrants billing 99215. "In my opinion, and in my practice, 99215 is not a common scenario," says Hayes H. Wanamaker, MD, an otolaryngologist at Central New York Ear, Nose & Throat Consultants in Syracuse. A general otolaryngologist infrequently sees a problem that justifies 99215. An academic, otology or head and neck practice treats more cases.

So when should an otolaryngologist ethically code a level-five established patient visit? Wanamaker suggests two types of patients that could warrant 99215. If the otolaryngologist documents two of the three key components that 99215 requires, you may bill this E/M service for a visit involving a patient with a:
 

  • complicated medical history that requires detailed reassessment
     
  • complicated exam, such as -

    1. a head and neck cancer patient

    2. or a patient with a neurotologic problem with changing physical findings, and/or a very difficult decision process, with many complicated treatment options.

    Here's an example of a potential 99215 patient profile: a diabetic (250.xx, Diabetes mellitus) patient with atrial fibrillation (427.31) on Coumadin who is returning for examination and discussion regarding therapy/treatment choices for a large acoustic neuroma (225.1, Benign neoplasm of brain and other parts of nervous system; cranial nerves), with neurologic findings that require detailed reassessment.

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