Wiki Pfsh for f/u

[Naveen Rachagolla]

Fellow Coders,

What to consider or how to take PFSH for F/U visit, And the statement below little confusing and iam unable to understand that can anyone help me in explaining that ?


Here it goes....

If a patient presents for follow-up on a chronic condition both the HPI and Past History should be consider. Positive findings of past diagnoses discovered on ROS should also be considered.

Thanks.

 

[scottshar]

PFSHx

PFSHx for f/u is going to help determine what E/M level to charge for. If none is documented, then the highest they could qualify for is either 99212 or 99213. If one past, family or social hx is documented and detailed exam or moderate MDM, then it would meet level 4. If all 3 hx areas are present, and 18 or more bullets in exam or high complexity MDM, then it may meet 99215.
Hope this helps!

 

[onetwothree]

I don't see any confusion in that statement. You have a chronic patient for the follow up visit, take an example of chronic illness like anemia. When the patient comes in for the follow up all the conditions are taken in to account in your pshf. History of present illnes (anemia)and what is the past history(anemia), and in system review you see the positive conditions of anemia in the patient. In considering the level of follow up, it goes accoring to your psfh. Is it any helpful?

 

[MikeEnos]

PFSHx for f/u is going to help determine what E/M level to charge for. If none is documented, then the highest they could qualify for is either 99212 or 99213. If one past, family or social hx is documented and detailed exam or moderate MDM, then it would meet level 4. If all 3 hx areas are present, and 18 or more bullets in exam or high complexity MDM, then it may meet 99215.
Hope this helps!

This is actually not correct. Follow-up outpatient visit codes 99211-99215 only require 2/3 key components. So theoretically they could have no history at all, or a minimally documented (problem focused) history, with a comprehensive exam and high level of MDM, and that would be sufficient documentation for a 99215.

Alternatively, if the history was expanded problem focused and the exam was expanded problem focused, but the visit was dominated by counseling and/or coordination of care, then time can be used to select the code. As long as they document the total time spent, document that greater than 50% of it was spent counseling or coordinating care, and they include briefly what the time was spent discussing, then they could select the level of code regardless of what HPI, ROS, PFSH, etc. they documented. 15 minutes of counseling in a 25 minute visit discussing medications, prognosis, treatment options, risk factors, etc woulld be sufficient for a level 4 follow up.