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amunosguren@yahoo.com

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Hi, i got CPC exam prep quetions thru CPC web site.Question number 21 under set "C"
15 years old male is seen by the pediatrician in his office for having excessive thirst and frequent urination.A urine dip is performed showing +3 sugar and with some ketones.Glucometer reading is done showing a bllod sugar range 500-600.Physician sends the patient with his father to the hospital for emergency admission and insulin drip.The pediatrician meets the patient at the hospital and performes a ditailed history,comprechensive exam,and high complexity MDM.
My answer was a 99223 but according AAPC its 99221.
Can some one explain me why?I believe they did a mistake?
thank you
 
An In Patient Admission requires 3 Key comonents. this case has a "Detailed History" thus 99221 to be a 99222 or 99223 ir would have to have a comprehensive history.

Cheryl
 
You need 3 out of 3 components to meet criteria for 99223. You only have two. Detailed history is 99221. You need Comprehensive history for 99223.
 
According to Pub. 100-04 Medicare Claims Processing Manual, chapter 12 - Physicians/Nonphysician Practitioners, section 30.6.9.1.F: When a physician performs a visit or consultation that meets the definition of a Level 5 office visit or consultation several days prior to an admission and on the day of admission performs less than a comprehensive history and physical, he or she should report the office visit or consultation that reflects the services furnished and also report the lowest level initial hospital care code (i.e., code 99221) for the initial hospital admission. Contractors pay the office visit as billed and the Level 1 initial hospital care code.
 
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