Wiki otitis media a level 4?

[kacurtis]

Hello! I work in pediatrics. We see ear infections all day. Providers cannot base on time as they take no time at all. While we rx antibiotics, the visits generally say "ear pain" as the problem for visit, not much HPI is taken, visit lists the exam and findings of ottits media, which to me equals a level 3 visit: 1 acute problem, history obtained from parent, rx ordered.
Providers read an article that states because they rx'd the med, it is a level 4 visit--every time. New med rx'd = level 4 automatically.
In my reading, I belive they still need to meet a few more requirements in regards to the amount and/or complexity of data to be reviewed and number of problems addressed.
Yet, because of this article, they are coding a level 4.
Would anyone mind weighing in?

 

[Orthocoderpgu]

MDM has three components. You need to meet at least two out of the three. Yes prescription drug management is in the Moderate category under risk. Now you need to factor in problems addressed and data. Your providers seem to be looking at only one element of MDM. You need to look at all three. Just getting information from a parent would not satisfy the data requirement under level 4.

 

[jkyles]

If I may hop on my soapbox briefly - I regularly get questions from coders who need a direct quote of CMS policy with a link to the official guideline or rule because their doctors don't believe them. So it is rather irksome to me when providers say "I read it somewhere" as proof they can do something.

Anyway. Even though history is no longer required to level an office visit, the CPT manual clearly states that at least 2 elements of MDM are required.

"To qualify for a particular level of MDM, two of the three elements for that level of MDM must be met or exceeded."

Prescription drug management is one element, so unless the article they read includes a citation to an AMA or CMS guideline that I'm not aware of, they still need to meet or beat the requirements for complexity and/or data.

 

[rthomas@impcna.com]

I work in a pediatric office as well and under the current documentation guidelines, when auditing charts, I have yet to find a visit for OM (no labs) that meets a level 4. Most of them are a level 3. I do have some providers that are having a hard time forgetting the old saying "If you prescribe a medication it's an automatic level 4." I bet they didn't pay attention to the date on article they read. They are also still trying to do level 4 visits on stable ADD follow up visits.