amexnikki23
Guest
SCENARIO?
Provider charged a 99214 in July and dx?d pt w/osteoarthritis of knee after some work-up.
Patient comes in two months later, still in pain, now wants a joint injection.
Provider now charges another 99214-25, and does not mention the knee or any other musculoskeletal area in his exam, yet he meets his exam quantity because of the other exam components (ie. psych, constitutional, cardio).
Performs the joint injection and charges a 20610 and charges for that along with the EM, using the 25 modifier.
MY THOUGHTS?
I believe this to be a level 3 even though the provider technically meets the criteria for 2/3 key components (Hx and Exam) due to the fact that he examined 2-7 ba/os HOWEVER, none of those exam components include anything related to musculoskeletal or the knee. And I thought 95 DGs stated "extended exam of affected OS/BA"- so what would be the overarching criterion here?
Provider charged a 99214 in July and dx?d pt w/osteoarthritis of knee after some work-up.
Patient comes in two months later, still in pain, now wants a joint injection.
Provider now charges another 99214-25, and does not mention the knee or any other musculoskeletal area in his exam, yet he meets his exam quantity because of the other exam components (ie. psych, constitutional, cardio).
Performs the joint injection and charges a 20610 and charges for that along with the EM, using the 25 modifier.
MY THOUGHTS?
I believe this to be a level 3 even though the provider technically meets the criteria for 2/3 key components (Hx and Exam) due to the fact that he examined 2-7 ba/os HOWEVER, none of those exam components include anything related to musculoskeletal or the knee. And I thought 95 DGs stated "extended exam of affected OS/BA"- so what would be the overarching criterion here?