Wiki Help with E/M level

ckelder

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I am having difficulty finding the documentation to support the 99214 coded by the provider. Any suggestions would be appreciated.

CC: paperwork .

History of Present Illness:
needs paperwork..She needs her FMLA form renewed.
needs referral extended at _____. She tried to call there and was told that her referral was about to expire.
needs flu shot
needs tramadol refill

Past Medical History:
Reviewed history from 07/16/2012 and no changes required:
PCOS
Morbid obesity
Fracture right humerus
Costochondritis
Insomnia

Family History:
Reviewed history from 05/04/2012 and no changes required:
FH Hypertension
FH Diabetes
pain syndrome
Family History Coronary Heart Disease female < 65
PCOS
obesity

Social History:
Sexually Active-no
Employed
Alcohol Use - no
Drug Use - no
Living with friends
works at _____________

Risk Factors
Tobacco use: never

Review of Systems
General
Denies fatigue and malaise.
ENT
Denies sore throat.
GU Complains of dysuria.
MS
Denies back pain, stiffness, and muscle aches.
Psych
Complains of poor sleep.

Vital Signs:
Patient Profile: 25 Years Old Female
Height: 62 inches (157.48 cm)
Weight: 330.19 pounds (150.09 kg)
(Measured Weight: 330lbs. 3oz.)
BMI: 60.61
BSA: 2.37
O2 Sat: 95 %
Temp: 98.6 degrees F (37.00 degrees C) oral
Pulse rate: 100 / minute
Resp: 18 per minute
BP sitting: 136 / 83 (right arm)
Cuff size: regular

Pt. in pain? no

Vitals Entered By: __________(September 27, 2012 12:54 PM)
Body Mass Index: 60.61 Last Mammogram: 00/00/00
Last Pap Smear: 2011
Do you smoke? No

No Known Allergies

Physical Exam
General:
well developed, well nourished, in no acute distress. obese.
Head:
normocephalic and atraumatic.
Eyes:
PERRL/EOM intact, conjunctiva and sclera clear with out nystagmus.
Lungs:
clear bilaterally to auscultation.
Heart:
normal S1, S2 without murmurs, rubs, gallops, or clicks.
Skin:
intact without lesions or rashes. hirsutism
Psych:
alert and cooperative; normal mood and affect; normal attention span and concentration.

Impression & Recommendations:
Problem # 1: NEED PROPHYLACTIC VACCINATION&INOCULATION FLU (ICD-V04.81)
Flu shot today.
Orders:
Detailed LC (CPT-99214)
Fluzone 3+yrs (CPT-90658)

Problem # 2: POLYCYSTIC OVARIAN DISEASE (ICD-256.4)
Will fill out FMLA form again for another year. She needs it to have more frequent bathroom breaks.
Orders:
Detailed LC (CPT-99214)

Problem # 3: COSTOCHONDRITIS (ICD-733.6)
Will refill tramadol today.
Orders:
Detailed LC (CPT-99214)

Problem # 4: BACK PAIN (ICD-724.5)
extended referral for ___________.
The following medications were removed from the medication list:
Percocet 5-325 Mg Tabs (Oxycodone-acetaminophen) ..... Take one to two tablets every 4-6 hrs as needed
Baclofen 10 Mg Tabs (Baclofen) ..... 1 bid as needed for muscle spasm

Her updated medication list for this problem includes:
Tramadol Hcl 50 Mg Tabs (Tramadol hcl) ..... 1 bid

Other Orders:
Fluvirin (CPT-90658)
Prescriptions:
TRAMADOL HCL 50 MG TABS (TRAMADOL HCL) 1 bid #60[tablet] x 2

Patient Instructions:
1) follow up with ________ about referral.

Influenza Vaccine
Vaccine Type: Fluvirin
Date/Time: 10/01/2012 5:25 AM
Site: L deltoid
Mfr: Novartis
Dose: 0.5 ml
Route: IM
Given by: _________
Exp. Date: 05/2013

Flu Vaccine Consent Questions
Do you have a history of severe allergic reactions to this vaccine? no
Any prior history of allergic reactions to egg and/or gelatin? no
Do you have a sensitivity to the preservative Thimersol? no
Do you have a past history of Guillan-Barre Syndrome? no
Do you currently have an acute febrile illness? no
Have you ever had a severe reaction to latex? no
Vaccine information given and explained to patient? yes
Are you currently pregnant? no
 
CC is paperwork, HPI needs FMLA form renewed? I do not see any medical necessity for this visit, never mind a 99214. There is no abdominal (polycystic ovary dx) or musculoskeletal (costochondirits, low back) exam. It's my understanding that you cannot bill an E/M for filling out paperwork or refilling prescriptions. The most I see that you can bill is for the flu shot. It will be interesting to see what other coders think.
 
Last edited:
I agree with Doreen. There is no HPI that would count. Conditions given in the impression are not addressed in the history or exam. I would discuss your concerns with the doctor. I would certainly not bill out this visit as a 99214 without an addendum (given the doctor truly did more work and just did not document). You have a right to be concerned.
 
I would also agree with Doreen. Talk with the doc about it because I don't see any medical necessity for a 99214.
 
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