Wiki Weekly visits - what to code?

[mmcneil03@yahoo.com]

Hi All,

I'm doing an audit for a pain clinic where some of the patients come in on a weekly basis to get their prescriptions filled (e.g. suboxone). The clinic codes 99212 when the patient is stable, 99213 when unstable with a necessary hx/exam and illness update. The visit supports those codes, however, I have been told by co-workers that they should not code 99212 or 99213 when they are seen that frequently and they have advised me to downcode them to 99211 and 99212. Can anyone provide feedback on this subject? Is this practice correct even though the visit supports the codes?

Thanks so much!

Megan

 

[OCD_coder]

If the provider see's the patient face to face for the service and is providing prescription management and the documentation supports a level 2 and 3 respectively how you have described; I agree with you that they are correct.

A 99211 is when the provider does not have face to face interaction with a patient for something as minimal is removing a Band-Aid or taking blood pressure. Medication management would not be appropriate for this level of service.

There are great examples in the CPT book, there might be one that fits to identify what a 99211 is used for.