Coding from The bottom up

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Presentation transcript:

Coding from The bottom up Capture the Coding, Outpatient Coding from The bottom up Thomas Weida, M.D. Professor Family and Community Medicine Penn State College of Medicine 4/20/2019 Thomas J. Weida, M.D. Thomas Weida, M.D., PennState College of Medicine

Office visit for a 50 year old female with dyspepsia and nausea who you last saw in the office four years ago. 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for a 32 year old female, established patient, with new onset RLQ pain. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Examples - Outpatient Office visit for a 68 year old female, established patient, for routine review and follow-up of non-insulin dependent diabetes, obesity, hypertension and CHF. Complains of vision difficulties and dietary noncompliance. Pt counseled concerning diet and current meds adjusted. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for the quarterly follow-up of a 45 year old male with stable chronic asthma requiring regular drug therapy. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for a 55 year old male, established patient, with increasing night pain, limp and progressive varus of both knees. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for a 70 year old female, established patient, with diabetes mellitus and hypertension, presenting with a 2 month history of increasing confusion, agitation and short term memory loss. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for a 60 year old female, established patient, diabetic, blood sugar controlled by diet. She now complains of frequency of urination and weight loss, blood sugar of 320 and negative ketones on dipstick. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Evaluation for a 28 year old male, established patient, with new onset of low back pain. Problem Points Self limited or minor (maximum of 2) 1 each Established problem, stable or improving Established problem, worsening 2 each New problem, no additional work up planned (maximum of 1) 3 New problem, with additional work up planned 4 Overall MDM Problem Points Data Points Level of Risk Straightforward Complexity (992x2) 1 Minimal Low Complexity (992x3) 2 Low Moderate Complexity (992x4) 3 Moderate High Complexity (992x5) 4 High 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Outpatient visit for a 77 year old male, established patient, with hypertension, presenting with a three month history of episodic sub-sternal chest pain on exertion. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for an established patient who lost prescription for hydrocodone. Returned for new copy. 99211 99212 99213 99214 99215 No Charge 4/20/2019 Thomas J. Weida, M.D.

Initial office visit for a 17 year old female with depression. Medical decision making of 99214 History and physical of 99215 99201 99202 99203 99204 99205 4/20/2019 Thomas J. Weida, M.D.

Office visit for reassessment and reassurance/counseling of a 40 year old female, established patient, who is experiencing increased symptoms while on a pain management treatment program. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Initial office visit for a 73 year old male with an unexplained 20 lb weight loss. 99201 99202 99203 99204 99205 4/20/2019 Thomas J. Weida, M.D.

Office visit for an established patient having acute migraine with new onset neurological symptoms and whose headaches are unresponsive to previous attempts at management with a combination of preventive and abortive medication. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for evaluation of recent onset syncopal attacks in a 70 year old woman, established patient. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Office visit for an established patient seen in follow up of clearing patch of localized contact dermatitis. 99211 99212 99213 99214 99215 4/20/2019 Thomas J. Weida, M.D.

Capture the Coding, Outpatient Examples of Medical Visits with Preventive Exam Which Warrant Separate Billing Strains requiring additional workup Infections requiring prescription Conditions referred to a specialist Chronic conditions with changed treatment Some examples of medical visits with a preventive exam which warrant separate billing and the -25 modifier include: Strains requiring additional workup, infections requiring a prescription, conditions referred to a specialist, or evaluation of chronic conditions that require a change to a current medical treatment plan. 4/20/2019 Thomas J. Weida, M.D. Thomas Weida, M.D., PennState College of Medicine

Examples of Medical Visits with Preventive Exam Which DO NOT Warrant Separate Billing Rash not requiring prescription or workup Bump that is normal Chronic condition that has not changed and no change to treatment plan is warranted 4/20/2019 Thomas J. Weida, M.D.

Waiver of Liability Advance Beneficiary Notice Advanced notification to the patient that his/her insurance may not cover a particular service. The Waiver serves as an agreement that the patient will be financially responsible for those services, i.e. cosmetic surgery. A blanket waiver is not acceptable. It is signed only for those services which may be determined to be “not medically necessary.” 4/20/2019 Thomas J. Weida, M.D.

Capture the Coding, Outpatient Review: 99214 1+ chronic illness with exacerbation 3 or more chronic stable illnesses Undiagnosed new problem with uncertain diagnosis Acute illness with systemic symptoms Acute complicated injury As a review, if nothing else is remembered, remember the 99214 medical decision making criteria as most practices under code these conditions: 1 chronic illness with exacerbation 2 or more chronic stable illnesses An undiagnosed new problem with uncertain diagnosis An acute illness with systemic symptoms or An acute complicated injury. All warrant a 99214. In CPT Simplicity Part II, we’ll focus on codes that are missed or underutilized in the office, as well as inpatient coding. 4/20/2019 Thomas J. Weida, M.D. Thomas Weida, M.D., PennState College of Medicine