In an Established Patient visit, I think that MDM should be one of the two. The reason for this is that MDM drives "Medical Necessity". If a young patient comes with with a cheif complaint of an earache, are you going to do a Comp History and a Comp Exam? No. That would be over-kill. How could you defend doing this in light of Medical Necessity? Was it necessary to review all of those systems? No. Your overall code selected should not be higher than MDM as a general rule. If it is, you need to be able to defend yourself in an audit stating why all the systems were reviewed.
Writing an RX gives you a RISK of Moderate. This does not gaurantee that this will give you a MDM of Moderate Complex or a guarantee of a level four visit. You must also take into consideration the other 2 compontents of MDM. If you are managing at least 3 established problems that are stable, or seeing the patient for a new problem with no additional work-up, then yes, your MDM would be Moderate, or if they are ordering and personally reviewing tests or records, that could also make your MDM moderate, but just saying that if the physician writes an RX makes it automatically a 99214 is not correct.
As far as the management of an RX, any prescription carries with it a risk, whether it is an antibiotic, skin cream or pain medicine. The patient has a chance of having a bad reaction to any drug, or if it does not work as planned, the physician incurs the extra work of correcting the RX. At our facility, if the patient does not get better on the RX given, the patient can call or may have to come back in for a new RX and that visit is not billed, so there is more work involved for the physician when he writes an RX. So, I feel that writing an RX is correct to be considered Moderate risk and to help in obtaining a higher E/M level.
Also, even though the MDM is supposed to be the driving factor in your level, the guidlines say 2 of the 3 must meet or exceed and it does not state that one of those components must be MDM. So in answer to Helen's question, technically, yes it could be HPI and Exam. I would however question a level 5 for an ear ache, but I could see a level 4 under the correct circumstances.
OK correct me if wrong...2nd guessing myself....E/M's include seven components, six of which determine the level of E/M. The six are hx, exam, mdm, nature of presenting problem, counseling, coordination of care and nature of presenting problem...
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I understand the argument it's just as a patient I think it stinks. I've taken my children in for ear infections just to get the amoxicillan (sp) that they'd taken many times over the years and if I would have been charge $182 for the visit I would have choked. All you need HPI "Her right ear has been hurting 2 days and we've put heat on it but no help. No fever. ROS "No rash, no cough. PMH: Gets 2-3 ear infections a year" New problem + RX=99214 What's not fair is the providers that give antibiotic for EVERY ear pain, sore throat or bug bite or pain meds for every back ache get a 99214 and then other providers that recommend over the counter or heat/ice get a 99213. The providers have picked up on this so guess what? Scripts are written 99% of the time. As for chronics...we've been told Vit D def and obesity can be counted as chronic so basically every person could in reality have 3 chronic dx's. I'm healthy but I have HTN but I'm also overweight and since I live in Oregon I have vit D deff (as do 75% of us in OR) Dr mentions all these and gives HTN med and 99214. I get it... I just don't like it.
Hi folks, i love seeing all the opinions going around about leveling out an E/M. doesn't it make coding fun? hehe
anyways...i had a question regarding "additional workup"
what does this actually mean? like what is considered additional workup? dont the points in amt & complexity data include this workup?
thanks~ any feedback would be awesome!