Wiki 99214...really?

Create Wiki
A

AprilSueMadison

Expert
Messages
257
Location
Tampa, FL
Best answers
0
Using an audit tool I have an office visit coming up as a 99214. Derm visit, 97 guidelines

HPI - I have location, context, modifying factors and associated signs.
I have an ROS of constitutional, integumentary, and hemat/lymph.
I have a complete PFSH.

Exam - I have a physical exam of head/face, neck, chest, abdomen, back, L up extremity, R up extremity, L lower extremity and R lower extremity and Orientation.

This is where I'm a bit lost.
MDM -
Psoriasis - established problem, improved, observe.
Acne - established problem, improving, changed medication
Keratosis Pilaris - new problem, prescribed meds

According to the categories on the audit tool (it calculates automatically) it is showing the following...
Number of Diagnoses or Management Options - Extensive
Amount and/or Complexity of Data to be Reviewed - None
Risk of Complications, Morbitity and/or Mortaility - This comes up as Moderate (low to presenting problem, no test ordered, moderate management due to scripts).

So I have: Detailed, Expanded Prob Foc, Moderate = 99214

Seriously, this is a 99214 because we prescribed meds for acne and keratosis pilaris? That seems insane.
 
Question: Why a complete PFSH for an established patient?
History elements should included only if they're pertinent to the presenting problem.
One the other hand, in most cases, if there's a new problem and a script written, it will usually come out to a 99214 on "paper."
When I began auditing charts seven years ago, I was TOLD that this would prove to be true over and over again. I didn't believe it it then; but, I do now.
It doesn't take that much to get to a 99214. :eek:

Medical necessity is whole other ball of wax! :p
 
CMS put put a transmittal last year with regards to visit levels, in this they stated that medical necessity is the over arching criteria for a visit level. Just because a level of exam CAN be performed, the real question is SHOULD it have been performed given the patient's presenting issue. you count only what pertains to the reason for the visit unless additional documentation can make a more extensive exam relevant.
I fail to see extensive under number of diagnsis and managment options, you have only one new problem and 2 establishe problems, this is not extensive, somewhere around limited maybe moderate but I would call it limnited and go with a 99213 for detaile history, exp focused exam. low complexity MDM
 
rryder1963 - I can't say specifically why a complete was done unfortunately. We do always check for history of cancer for both personal and family. We have to document certain elements of social for both MU and PQRS, but in regards to various cancers we always document tobacco and alcohol since they contribute. In this case though, it was just done.

mitchellde - The First Coast Service Options E/M tool calculated it as extensive, as did another chart I used (2 self-limited + 3 for one new problem = 5 which is extensive). So that is how that came up.

Based on the location of the acne and psoriasis, the exam should have included at the very least those body parts, which it did and led to a new diagnosis and new treatment.

The catch is I just don't think this minor exam and the writing of a new script should be a 99214. All of these are easily manageable diagnoses that should clear up with the medication. The PFSH doesn't necessarily pertain to this visit in any way. I just need to be sure when the doctor comes to me and says "Well the E/M calculator says 99214, why did this go out as a 99213?"...I can answer easily and honestly.

mitchellde - Do you have a link to that transmittal by any chance?
 
99214 requirements as I understand them:

HPI of 4 or more
ROS of 2 or more
PFSH 1 or more
Exam areas of 4 or more
Decision making of moderate intensity (needing 2 of 3 of multiple dx/mgmt options, moderate data review, moderate risk)

99214 makes sense to me
 
You must log in or register to reply here.
Top