jberg@itctel.com
Guest
In our clinic, patients that are new to insulin pumps come in and met with our Pharm.D for education, etc. We bill out under a MD. Here is the typical office encounter:
Reason for Appointment
1. New insulin pump start
History of Present Illness
Constitutional:
Patient has been a diabetic for several years. She had a pump about 9 years ago. She presents today for new pump start.
Current Medications
Taking
? Lantus 100 UNIT/ML Solution 34 units at bedtime
? Humalog 100 UNIT/ML Solution 8 units am, 15 units with lunch and supper
Allergies
N.K.D.A.
Assessments
1. Type 1 diabetes mellitus - 250.01 (Primary)
Treatment
1. Type 1 diabetes mellitus
Continue Humalog Solution, 100 UNIT/ML, take as directed, via pump
Stop Lantus Solution, 100 UNIT/ML, 34 units, Subcutaneous, at bedtime
Continue Contour USB Blood Glucose Sys test strips, 8 times a day
Start Bayer Contour Next Test Strip, as directed, 200, Refills 5
Notes: Pt here today for insulin pump hook up per Dr ?????.. PHYSICIAN will provide follow up. PHYSICIAN in the room for 20 minutes to address all questions. Educated pt was previously on Lantus and Humalog. Patient will only use humalog in the pump. Educated pt will have follow up with PHYSICIAN on 2/12 or 2/13, but can call before if any questions or concerns. Educated pt will need to check his BG readings about 8 times a day and bring all the readings to his appointment with PHYSICIAN. Educated pt this will help PHYSICIAN make adjustment to the pump settings. Educated pt we start the pump with conservative settings and will likely change over time. Insulin pump settings per Dr ????. based off her current insulin regimen: basal: 1.2 units/ hour Insulin to carb: 1 units/8 grams CHO Correction factor: 1 unit to decrease BG by 33 mg/dl Discussed introduction to insulin pump therapy, basic features, basic programming, bolus wizard calculator, reservoir and infusion sets, trouble shooting for site, tubing, insulin, pump and optimizing options for the pump. Briefly discussed temp. basal feature, dual/square wave bolus and the option to link the meter to the pump. Pt did want to link the meter and this was completed. Called prescription to Shopko in pharmacy for strips and lancets for new meter. Pt verbalized understanding of this information. Educated pt that lots of information was discussed and may feel overwhelmed. Provided pt with 800 number for 24 hour medtronic customer service for pump questions and discussed when to contact his provider. She has had a pump before so some of the material was review. She did a great job with the education. Educated to review books and online training at anytime, but can call with questions or concerns as well. Total time spent- 2 hours.
This is how they want to code this encounter 99215 and then 99354 for the additional time spent. I am not comfortable doing this as the note specifies that only 20 minutes was spent with the physician.
Any help with this would be appreciated.
Reason for Appointment
1. New insulin pump start
History of Present Illness
Constitutional:
Patient has been a diabetic for several years. She had a pump about 9 years ago. She presents today for new pump start.
Current Medications
Taking
? Lantus 100 UNIT/ML Solution 34 units at bedtime
? Humalog 100 UNIT/ML Solution 8 units am, 15 units with lunch and supper
Allergies
N.K.D.A.
Assessments
1. Type 1 diabetes mellitus - 250.01 (Primary)
Treatment
1. Type 1 diabetes mellitus
Continue Humalog Solution, 100 UNIT/ML, take as directed, via pump
Stop Lantus Solution, 100 UNIT/ML, 34 units, Subcutaneous, at bedtime
Continue Contour USB Blood Glucose Sys test strips, 8 times a day
Start Bayer Contour Next Test Strip, as directed, 200, Refills 5
Notes: Pt here today for insulin pump hook up per Dr ?????.. PHYSICIAN will provide follow up. PHYSICIAN in the room for 20 minutes to address all questions. Educated pt was previously on Lantus and Humalog. Patient will only use humalog in the pump. Educated pt will have follow up with PHYSICIAN on 2/12 or 2/13, but can call before if any questions or concerns. Educated pt will need to check his BG readings about 8 times a day and bring all the readings to his appointment with PHYSICIAN. Educated pt this will help PHYSICIAN make adjustment to the pump settings. Educated pt we start the pump with conservative settings and will likely change over time. Insulin pump settings per Dr ????. based off her current insulin regimen: basal: 1.2 units/ hour Insulin to carb: 1 units/8 grams CHO Correction factor: 1 unit to decrease BG by 33 mg/dl Discussed introduction to insulin pump therapy, basic features, basic programming, bolus wizard calculator, reservoir and infusion sets, trouble shooting for site, tubing, insulin, pump and optimizing options for the pump. Briefly discussed temp. basal feature, dual/square wave bolus and the option to link the meter to the pump. Pt did want to link the meter and this was completed. Called prescription to Shopko in pharmacy for strips and lancets for new meter. Pt verbalized understanding of this information. Educated pt that lots of information was discussed and may feel overwhelmed. Provided pt with 800 number for 24 hour medtronic customer service for pump questions and discussed when to contact his provider. She has had a pump before so some of the material was review. She did a great job with the education. Educated to review books and online training at anytime, but can call with questions or concerns as well. Total time spent- 2 hours.
This is how they want to code this encounter 99215 and then 99354 for the additional time spent. I am not comfortable doing this as the note specifies that only 20 minutes was spent with the physician.
Any help with this would be appreciated.