Coding patient encounters ii
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Coding Patient Encounters II. EPISODE 2 Determining the “level” of the encounter. Objectives. Understand the basic rules: Physician payment rules Basic CPT and ICD coding rules Be familiar with the 3 criteria for selecting the correct EM Code. The “Art” of CPT Coding.

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Coding Patient Encounters II

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Coding patient encounters ii

Coding Patient Encounters II

EPISODE 2

Determining the “level” of the encounter


Objectives

Objectives

  • Understand the basic rules:

    • Physician payment rules

    • Basic CPT and ICD coding rules

  • Be familiar with the 3 criteria for selecting the correct EM Code


The art of cpt coding

The “Art” of CPT Coding

  • First select the code based on the “feel” of the visit (not check-up) – how complex, how much time

  • Then validate your code using a E/M tool (E/M = evaluation and management)


The art of cpt coding1

The “Art” of CPT Coding

  • The “Feel”

    • 99211 = nurse visit

    • 99212 = easy, brief problems

    • 99213 = average, usual problems

    • 99214 = “oh no!”

    • 99215 = after visit you think “I just ran a marathon”

  • Why should you care?

    • > $40 difference between level 3 and 4!


99212 typical scenarios

99212 Typical Scenarios

  • Diaper rash

  • OM recheck and resolved

  • Otitis externa

  • Thrush


99213 typical scenarios

99213 Typical Scenarios

  • Fever and pharyngitis

  • UTI-cystitis

  • URI and Otitis

  • Mild LRI’s

  • Moderate Injury

    *Most acute uncomplicated problems


99214 typical scenarios

99214 Typical Scenarios

  • Chronic or Multiple problems

    • Headaches, abdominal pain

    • Fatigue, anorexia

    • Asthma, diabetes

  • School and Behavioral Problems

    • ADHD return visits

  • Acute Complicated Illnesses

    • Fever without focus

    • Influenza


99215 typical scenarios

99215 Typical Scenarios

  • Diabetes complicated by illness

  • Headaches with vomiting

  • Disabling abdominal pain

  • Fatigue and anorexia in adolescent

  • Fever without focus for more than 60 days

  • Initial evaluation for ADHD


The science of coding

The Science of Coding

  • Three Criteria for selecting the correct E/M Code:

    • History

    • Physical Examination

    • Medical Decision Making

  • For established patients, must have 2/3 areas at same level to qualify (3/3 for new patients)


Levels of history

Levels of History


What constitutes the elements of the history

What Constitutes the Elements of the History?


Levels of physical exam

Levels of Physical Exam

Either the 1995 guidelines or 1997 guidelines may be used, but most general pediatricians use the 1995 guidelines as the 1997 guidelines were written with specialists in mind.


Body areas organ systems in the pe

Body Areas/Organ Systems in the PE


Criteria for selecting the correct em code

Criteria for Selecting the Correct EM Code

  • History and Physical form the 1st two of the key criteria in coding. In the next set of slides and the conclusion of the trilogy “Coding”, we will discuss medical decision making as the third component.


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