lhoot
Guest
Good Morning,
Need some help untangling the logic for visits for medication refills in different visit settings.
Pt is seen for asthma med refill. No exacerbation or issues are noted. Comprehensive History and Comprehensive Exam is done.
According to the established matrices for code selection, I'm arriving at the following codes:
If this visit is a new pt in an office visit setting the code is 99204.
If this visit is in an ED, the components qualify for either a 99283 or a 99284. (Since the pt isn't experiencing any issues, I would tend to choose 99283.)
If this is an established pt in an office visit setting, the components qualify for a 99214. (However, since the patient is an established patient, the comprehensive history and exam may be overdocumentation and I would feel more comfortable with a 99213.)
In an ED or new pt office visit setting, the physician has not seen the patient before, so the comprehensive exam and history are reasonable expectations. A prescription is given, so there is medication management for a moderate risk level. Are there any other considerations, guidelines or official direction that would require this visit scenario to be a level two in any of these circumstances? I understand that many facilities and practices put policies of their own in place to fill in the grey areas of E/M coding and I'm interested in what the industry standard is; however, I'm more interested in any official guidance for this.
Laura
Need some help untangling the logic for visits for medication refills in different visit settings.
Pt is seen for asthma med refill. No exacerbation or issues are noted. Comprehensive History and Comprehensive Exam is done.
According to the established matrices for code selection, I'm arriving at the following codes:
If this visit is a new pt in an office visit setting the code is 99204.
If this visit is in an ED, the components qualify for either a 99283 or a 99284. (Since the pt isn't experiencing any issues, I would tend to choose 99283.)
If this is an established pt in an office visit setting, the components qualify for a 99214. (However, since the patient is an established patient, the comprehensive history and exam may be overdocumentation and I would feel more comfortable with a 99213.)
In an ED or new pt office visit setting, the physician has not seen the patient before, so the comprehensive exam and history are reasonable expectations. A prescription is given, so there is medication management for a moderate risk level. Are there any other considerations, guidelines or official direction that would require this visit scenario to be a level two in any of these circumstances? I understand that many facilities and practices put policies of their own in place to fill in the grey areas of E/M coding and I'm interested in what the industry standard is; however, I'm more interested in any official guidance for this.
Laura