_____ of _____, A Medical Group . Patient: O, S. Date of Service: 1/27/09 . Physician: F . Original Coding RVU’s: 99204-25…………………..3.93 . 73564-RT,TC……………..0.77 . 73564-RT,26……………..0.31 . Total……………………5.01
Medical Coding Mini Course Notice to user: The materials contained in this mini course are copyrighted and may not be 99204 (described as an office or other outpatient visit for the evaluation and management of a new patient).
Medicare Coding and Billing New patients 99201 99202 99203 99204 99205 Established patients 99211 99212 99213 99214 99215 New Patients Require All 3 Levels Code History Exam Decision Making 99201 Problem focused Problem focused Straightforward 99202 Expanded problem focused
DOCUMENTATION OF MEDICAL NOTES (Based on 1995 Guidelines) General Principles Inconsistent coding patterns among members of the same specialty/same group/same Level 99204, 99214 require at least 4 (or status of at least 3 chronic health conditions)*
Many medical groups under perform financially because of misinformation and bad habits. coding evaluations for your practice by bringing attention to specific procedure codes 99204 Office/outpatient visit, new, level 4
Coding by Key Components History Chief Complaint (CC) History of present illness (HPI) Problem Points Data Points Risk Complexity of Medical Decision Making -t d: 0 10 Minimal Straightforward 99204 COMP COMP Moderate 99214 DET DET Moderate
3 of 3 2 of 3 Major Criteria (History, PE, MDM) 99204 99214 Element Moderate Complexity New and Established Level 4 Visit Main Differences between Level 3 and Level 4 Established Visit The Importance of Medical Necessity Rational Physician Coding Slide 25 Slide 26 Slide 27
Medical decision making of low complexity. services are intended to be an important element of the coding system. The clinical examples, 99204 Initial office visit for a 34-year-old female with primary infertility for evaluation and counseling.
MEDICAL DECISION MAKING OF MODERATE COMPLEXITY (need to meet 2 of 3) A. Diagnosis and management (3 points needed) 99204 has the same requirements as 99214 except:ROS, 10 or more; PFSH,3 elements;exam,18 bulleted elements from at least 9 systems.
Coding Specifications Codes required to document patient has chronic 99203, 99204, 99205 n 99212, 99213 are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can
CPT & ICD-9 CODING Debra Dockter NP-BC are numbers assigned to every task & service a medical practitioner may provide to a patient. New patient visit CPT 99204 Established patient visit CPT 99215 E/M Coding: Level of Visit
CPT Coding Guidelines for Office Visits December, 1998 99204 comprehensive ext. (≥4 elements) complete (≥10 systems) complete (≥ 2 areas) Medical Decision Making type ofpatient type of details of Medical Decision Making new est.
Inconsistent coding patters among members of the same specialty/same group/same location. Level 99204, 99214 requires at least 4 CODING REQUIREMENTS MEDICAL DECISION MAKING
DRIVE CODING Documenting Medical Decision Making The Real Meat of Internal Medicine Medical Decision Making 99204 99214 Low 99203 99213 Straight-forward 99201/02 99212 Level of MDM Case #1 • I did review labs with him. Glucose, lipids, HgA1c, PSA.
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