Wiki Coding for Accutane/Acne patients established

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Hi out there, I need a guide to show me how I should code this visit.

Established pt comes in for his monthly acne follow up being treated with Accutane. I have a P.A. that I work with that insists that these patients should be coded as a level 4 (99214) every time they are seen. I disagree,
in regards to E & M and medical decision making, I say this should be coded as a 99212, here is my reasoning...

A - Amount of diagnosis or treatment options = 1 established problem stable
B - Level of Risk = moderate for prescription drug mgmt.
C - Amount of data to be reviewed = 1 for labs reviewed

Final result for complexity
A - minimal
B - moderate
C - minimal
___________
99212 - 2 of three meet

Is this correct?

Thank you

dscoder74
 
Hello, We do bill 99214 or 99213. Accutane is a high risk medication (V58.69), we are evaluating the acne and the medication at each visit.
 
Hi Linda,

I am curious to find out, when you use the E/M evaluation sheet under complexity..

A - Number of diagnosis or treatment options
answer - 1 if the acne is stable and improving and it is documented as such

B - Risk of complications and/or Morbidity or mortality
answer - High - due to drug therapy requiring intensive monitoring for toxicity

C - Amount and/or data to be reviewed
answer - 1 review and/or order of clinical lab tests

Line them up 2 of three or middle and you get 99212. Am I missing something?

Thanks!


dscoder74
 
I agree with dscoder. Although I know many providers who feel that they are providing a level 4 visit because accutane is a high risk med, but if all is stable it really shouldn't be a 99214.
 
Accutane followup

Lisa Curtis said:
I agree with dscoder. Although I know many providers who feel that they are providing a level 4 visit because accutane is a high risk med, but if all is stable it really shouldn't be a 99214.
Click to expand...

Hi Lisa,

Thanks for the reassurance!

dscoder74
 
Sorry took so long for me to reply. I agree to disagree, especially with Accutane. We do a thorough ROS, PFSH and PHI on the condition and the medication at each visit. If there is a side effect we may end up coding 99214. Generally for the amount of work the physician performs at each visit we bill a 99213 at least.
We order and review labs, prenancy test (if appropriate), rx for accutane (high risk)and continue with contraception, rtn appt documented
 
99212

Based on the documentation provided (as per dscoder74's first post) I get a 99212.

If your physician(s) document(s) more, lspray, then you could legitimately get level 99213 or 99214.

I agree with dscoder and Lisa Curtis for this case.

F Tessa Bartels, CPC, CPC-E/M
 
I agree with dscoder, Lisa and Tessa too on this one - with the level 2... not much to go on to support anything higher.
{that's my opinion}
 
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