Wiki Risk required for a 99245 eye consult

[fhromeo30]

I have a provider who is billing a 99245 yet his risk tops out at 'prescription drug management' for eye drops. He is not understanding my explaination. Does anyone have examples of what would constitute a level 5 for risk? I know urgent surgery on the eye would count, but any others?

 

[mzkandyd]

Explain to him that Rx management is only equivalent to a level 3 (detailed MDM) and he needs more than that.

I have an audit template sheet that you can show him. I would code out his exam. If he is treating same day (Rx mgt) then the consult is not billable. It would need to be downcoded to an established or new patient visit.

Please email me off of the forum for help.