History
Evangelina,
I believe you are referring to counting the ROS and PFSH as complete when the physician documents the reason it cannot be completed (e.g. patient in coma, no family members present).
Yes, WPS Medicare requires us to use the 99499 Unlisted E/M service, and charge the equivalent fee of the E/M we WOULD have charged had the history been complete.
For example ... if you had a comprehensive exam and high MDM with a critically injured patient who was unresponsive (so you couldn't get a complete history), you would use 99499 but base you fee on 99285. (Of course if you provided critical care of 30 minutes or more, you could use the 99291-99292 codes instead.)
Wouldn't it be nice if everyone did things the same way!? (When they let me rule the world, that will be the first rule I implement ... well, right after chocolate not having any calories.)
Hope that helps.
F Tessa Bartels, CPC, CEMC