Wiki Help needed billing ENT e/m w/ '95 guidelines...

[bungalowgirl]

I work in ENT specialty, one of the Drs has to bill using 95 guidelines (that's a whole story in itself). I'm used to coding their services under '97 guidelines so am not super comfortable using the '95. My question is, for a New pt office visit, to count the Constitutional system does the Dr HAVE to record the 3 vitals? OR can he just note general appearance &/or communication ability & quality of voice? I can't find any information that clarifies whether vitals HAVE to be recorded for Constitutional to be counted( already ck'd cms). Any help (and your source if you can share) will be welcomed... sources help so I can provide substantiation to my Mgr... Thanks!!

 

[ENTcoderConnecticut]

1) Are we talking about ROS? If so:
System review is based on questions not on physical exam. It is the patient's own report. Look at page 7 of the AMA's CPT 2014.
If I'm not mistaken, constitutional symptoms, is an element of ROS. ROS equal to 1 is 99201.
But to be clear, being this is ENT, then you may add an addtional element to your count for ROS. It is is under "ear nose mouth, throat". Also, another element can be Psychiatric as that pertains to the patient's reported emotional state.
If they document that part, then your count is up to 2 or even 3. So then it's Extended ROS (2-9 elements).
Typically for 99203, you need 4+ HPI elements with 2+ ROS and 1FSH

2) Regarding constitutional for the actual exam:
see page 51 of the PDF doc that I have noted at the bottom of this post! It states 3 out of 7 vital signs documentation.

3) By the way, you can impress with the 9924_ codes. The 3 R's. Refer, Render, Report. If another Doc in another practice refers to your ENT, and your ENT Renders, and sends a Report back. (extra $ for the practice). Of course Medicare and Medicaid don't pay for them, but most every other insurance does!

4) Lastly, check out this document, and it's from CMS. Pretty snazzy evidence.

http://www.cms.gov/Outreach-and-Edu.../Downloads/eval_mgmt_serv_guide-ICN006764.pdf