Wiki Coding for GI

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kathymoon

kathymoon

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I need a second opinion. 99203 or 99204? Gastroenterologist see patient referred by PCP. HPI covers duration, timing, signs and symptoms and quality. Diagnoses include dyspepsia, rectal bleeding, and diarrhea. Complete review of symptoms and all components of PFSH.
1. = Comprehensive History.
2. Comprehensive physical exam documented
Physician orders a diagnostic EGD and a diagnostic colonoscopy.
To me this is a 99204. Multiple new problems to this physician with additional workup (endos) and ordering diagnostic endoscopies (no identified risk factors).

Second scenario, he is not ordering endoscopies but is ordering CT scans or Barium enemas. Still 99204?
He wants to continually code 99203, have explained the difference and he still codes them 99203. Am I right that these should be 99204? Thanks.
 
Hi,

I have coded with 99203 because of low MDM. The multiple new problem with additional workup (CT/Barium enema) and ordered non cardiovascular imaging study with contrast and its fall under low risk.
 
I would agree that in the first scenario this would be a 99204. The MDM would be moderate, not low - New problem with additional work-up is 4 points and the risk is moderate for the Endoscopy with no identified risks.

The second one if he is only ordering CT scan or barium enema, then I would say that would be 99203 since those fall under Low in the risk table and with only one or two points under data reviewed, you wouldn't get enough to get a Moderate MDM.
 
My question....is this a (Consultation with the GI physician) or is this an (office visit) with the GI physician?

This would be a completely different scenario if this is a consultation.

For the first case, I would code a 99204 and the second scenario would be a 99203 if just ordering CT scans.

Hope this helps :)
 
So my question: Is this possibly of moderate risk because of the "presenting problem." We have a "new problem with uncertain diagnosis" which brings the risk factor to a Moderate?

Feedback please:
 
I completely disagree with stating the second scenario should be a 3. For all we know this could actually be a 5. This could be a high risk patient due to something else going on, lack of a planned endo and presence of an order for a CT mean nothing when you don't have the complete picture.

To truly level the second scenario we need more information than provided so my comments below are just in regards to feedback on MDM leveling not in response to the second scenario.

MDM is 2 of the 3, meaning you could hit Moderate without even considering the table of risk.

The table of risk itself is wherever you fall that is the highest. Lack of an invasive procedure does not automatically drop the level of risk, since like you indicated there is more than 1 column to consider.

Yes, a new problem with uncertain prognosis, is definitely a valid way to support Moderate in the table of risk.

Just my take on it,

Laura, CPC, CPMA, CPC-I, CEMC
 
Thank you Laura. That is exactly what I have been thinking. But when people start questioning I begin to second guess myself. Just need to stick to my guns.

Thanks.
 
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