Wiki Need help coding this level of E/M New Patient

bmanus

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Mount Pleasant, NC
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CC: abnormal vulvar and vaginal biopsy result
HPI: is a pleasant 38 yo G4P2-0-2-2 female who presented with biopsy proven VIN 1 and VaIN1. She went to planned parenthood a months ago for IUD insertion. Per patient, pelvic exam revealed a polyp like structure obstructing cervical OS. IUD was eventually placed. She went back a week later for f/u and polyp was not found on exam, however, valvar and vaginal biopsy was performed for palpable bumpiness in the area. She has a long history of HPV infection and a history of genital warts 11 years ago. Her biopsy (10/25/12) showed VIN-1 and VaIN1. She feels sore in her perineal area but otherwise does not have other complaints.
She has regular periods. She has not had a PAP test for years. She just had a HIV testing a month ago and per patient it was negative. She is a nonsmoker.
PMH:
Hx of HPV
Anemia
Pneumonia in 2001 and 2006
Frequent pyelonephritis that required hospitalization
PSxH:
Surgery for right kidney stone, complication was postop bleeding that required extended hospital stay 2010
FH:
Mother: 68, alive with recurrent ovarian cancer, initially diagnosed at age 63
M. Aunt: breast cancer survivor, 53, diagnosed at age 38
MGM: uterine cancer/breast cancer, deceased
PFM: breast cancer survivor
M. Great aunt: ovarian cancer, deceased.
SH:
Divorced, works at a wire store. Nonsmoker. Dose not drink. Hx of marijuana, LSD, Speed and heroin long time ago in college.
OB/Gyn hx:
G4P2-0-2-2, NSVD x 2 15 and 3 years ago. Coitarche 15; number of lifetime partners 9; currently sexually active; nenarche 12; lmp: 2 weeks ago. Birth control IUD. Rest of gyn hx see HPI.
ROS:
A 14-system ROS was performed, in addition to the elements documented in HPI was positive for the following: unable to sleep, weight changes, bleeding tendency, frequent colds, frequent UTI, abdominal pain, swollen feet, depression, partner has genital warts, bleeding with intercourse.
PE:
Gen: pleasant female in NAD
HEENT: normocephalic, anicteric, EOMI
Neck: supple, no thyromegaly
CV: RRR, no m/r/g
Lungs: CTAB
Abd: soft, nontender
Ext: WWP, no edema
External genitalia: normal contour, visible raised roughness on distal vaginal wall and vulvar area, Subtle hypopigmentation noted in vaginal mucosa. Cervix appears grossly normal with no lesions.
Pathology:
10/25 vulvar biopsy- VIN I
10/25 vaginal biopsy-VaIN1
Assessment and plan:
38 yo G4P2 female with history of genital HPV infection
Recent biopsy proven VIN I and VaIN1
Genetic susceptibility to ovarian cancer


- Discussed topical treatment with Efudex. PARQ held and she agrees to proceed with treatment. Instruction given in detail. She will use 1g intravaginally and on her vulvar area, once a week for 10 weeks. We will see her in 5 weeks for mid-treatment check.
- We discussed in length her her family' risk for hereditary Breast and Ovarian Cancer syndrome and her increased risk for developing ovarian cancer and breast cancer. we discussed that her lifetime risk to develop ovarian cancer can be more than 8-12% as compared to 1 to 2% general population lifetime risk to develop ovarian cancer. Her risk for developing breast cancer is also increased. A genetic counseling will perform a complete cancer risk-analysis and discuss further testing.
I think is a 99203. any help would be greatly appreciated.
Beth Manus
 
coding level of patient

Hi Beth,

Based on 1995 E/M guidelines I came up with a 99202. WPS is our Medicare Carrier and they have not made is clear the difference between expanded problem focused exams and detailed, however, where I work we have developed what we feel is a detailed exam in several of the organ systems. When I used our guidelines for a detailed exam I didn't come up with enough for any of the organ systems examined to meet a detailed exam. If your JMAC carrier is different you may want to look at what they require for an EXP vs a detailed exam.

Another option is to possibly bill based on time. Your provider did not document the amount of total time spent with the patient and he/she would need to document the total amount spent and more than 50% of that time was spent counseling. Your provider has already documented what was discussed as that is a requirement. You want to query your provider about how much total time was spent. To bill a 99203 a total of 30 minutes will need to be spent with the patient and of that more than 50% of the 30 minutes be of counseling/coordination of care.

Linda
 
Hi,

This is how i audited...Using 95 guidelines

History is Expanded P F( HPI is Brief as there are only 3 components, Ros Complete, PFsh Complete) As history require all 3 out of 3 comonents and as HPI is falling behind the other 2 components are pulled down)

Exam is Expanded P F ( Limited Exam of 2-7 O/S or body areas qualifies for EPF Exam, and Detailed exam of 2-7 O/S or body areas qualifies for Detailed exam, Here only one ogran system exam is performed in detail which is GI system so i considered it as EPF EXAM.

MDM is Moderate ( Because MDM requires only 2 out of 3 of the MDM table, as it is a new patient and new problem to the provider i consider it as 3 points and 1 for amount of date... and it is a moderade risk( Prescription Drug management.)

For new patient 3 out of 3 are required to qualify for a level of code, it goes with 99202.


And i totally agree with Linda about time factor in the second paragraph.
 
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