Wiki MDM for covid exposure

[schlosser0429@yahoo.com]

I code for PEDIATRICS. Can you please tell me your thoughts on the below scenarios? Some providers are disagreeing with me and I am second guessing myself

1. Pt is having no symptoms, had stomach pain but is resolved. NO Covid exposure. Parent says patient needs COVID test to return to school. COVID test performed. Mother is here with patient providing history
Provider is billing 99213, I say it's a 99212?

2. Pt is having no symptoms but had COVID exposure. Needs COVID test to return to school. COVID test performed.
Mother is here with patient providing history
Provider is billing 99213, I say it's a 99212?

3. Pt has cough, congestion, headache and had COVID exposure. Needs COVID test to return to school. COVID test performed.
Mother is here with patient providing history
Provider chose for coder to review, I say it's a 99213?

4. Pt has cough, congestion, headache but had NO COVID exposure. Needs COVID test to return to school. COVID test performed.
Mother is here with patient providing history
Provider chose for coder to review, I say it's a 99212?

Thanks in advance.

 

[njycarter17]

I code for PEDIATRICS. Can you please tell me your thoughts on the below scenarios? Some providers are disagreeing with me and I am second guessing myself

1. Pt is having no symptoms, had stomach pain but is resolved. NO Covid exposure. Parent says patient needs COVID test to return to school. COVID test performed. Mother is here with patient providing history
Provider is billing 99213, I say it's a 99212?

2. Pt is having no symptoms but had COVID exposure. Needs COVID test to return to school. COVID test performed.
Mother is here with patient providing history
Provider is billing 99213, I say it's a 99212?

3. Pt has cough, congestion, headache and had COVID exposure. Needs COVID test to return to school. COVID test performed.
Mother is here with patient providing history
Provider chose for coder to review, I say it's a 99213?

4. Pt has cough, congestion, headache but had NO COVID exposure. Needs COVID test to return to school. COVID test performed.
Mother is here with patient providing history
Provider chose for coder to review, I say it's a 99212?

Thanks in advance.

1. I would agree with you, 99212 (minimal problem and low data -ordered one lab test and assessment requiring an independent historian)

2. I would agree with you, 99212 (minimal problem and low data -ordered one lab test and assessment requiring an independent historian)

3. I would agree with you, 99213 (low problem - acute uncomplicated illness and low data -ordered one lab test and assessment requiring an independent historian)

4. I would say it is 99213 (low problem - acute uncomplicated illness and low data -ordered one lab test and assessment requiring an independent historian)

 

[schlosser0429@yahoo.com]

1. I would agree with you, 99212 (minimal problem and low data -ordered one lab test and assessment requiring an independent historian)

2. I would agree with you, 99212 (minimal problem and low data -ordered one lab test and assessment requiring an independent historian)

3. I would agree with you, 99213 (low problem - acute uncomplicated illness and low data -ordered one lab test and assessment requiring an independent historian)

4. I would say it is 99213 (low problem - acute uncomplicated illness and low data -ordered one lab test and assessment requiring an independent historian)

Thank you! Another question...in scenario 1 & 2 .would the risk also be minimal? In scenario 3 & 4 would risk be low?
Again, thank you for your assistance.

 

[csperoni]

Thank you! Another question...in scenario 1 & 2 .would the risk also be minimal? In scenario 3 & 4 would risk be low?
Again, thank you for your assistance.

Unless there was other decision making not provided here, just the covid test itself I would consider minimal for risk.
Particularly for the symptomatic patients (#3 & #4), I would imagine the provider gave some sort of treatment plan. Tylenol PRN for headache. Robitussin for cough every 4 hours. The risk would be low for OTC meds. Any prescription meds would make the risk moderate. If just rest, gargle, etc, then risk is minimal.

 

[njycarter17]

Thank you! Another question...in scenario 1 & 2 .would the risk also be minimal? In scenario 3 & 4 would risk be low?
Again, thank you for your assistance.

Hello - sorry for the late reply, but yes I agree with you in scenario 1 & 2 would be minimal risk and in 3 & 4 I feel it would be a minimal risk since I feel there is no minimal risk documented. I got low problems and low data (mother historian and one lab test ordered) - That is how I got the 99213.