Wiki Level of Code for Medication Refills

[kathy a]

I bill for a workers comp group.Patient is coming in for medication refills.The physician has documented a detailed to comp exam,a detailed to comp ROS.IN medical decision making he gets a low complexity for that as patient is doing fine but needs refills. I saw a webinar that said if patient is just basically coming in for re-fills it would code out at a level 3, that the physician doesn't have to be coding all that info and just because he does it does not warrant a level 4 or 5. What is anyones opinion on this? Thanks Kathy

 

[MnTwins29]

Would need more specifics to give a true code level. But assuming that this is for one chronic condition that is stable with the meds and the patient is simply getting a refill, it would be hard to prove the medical necessity to perform a comprehensive history and exam. So, at best, I would say that it should be a 99213 - but again, that is very general and without specifics, don't take this as the final word!

 

[kathy a]

Thank-you. That is what I always code it out as. That is what they are coming in for. I was taught that the Medical Decision Making drives the exam.