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E/M Level 99214
Can we bill an office visit 99214 with G8420?
My doctor specializes in Kidney diseases and he was curious.
Clinical Examples for 99214
Office visit for an established patient now presenting with generalized dermatitis of 80% of the body surface area. (Dermatology)
Office visit for a 32-year-old female, established patient, with new onset right lower quadrant pain. (Family Medicine)
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. (Pain Medicine)
Office visit for a 30-year-old, established patient, under management for intractable low back pain, who now presents with new onset right posterior thigh pain. (Pain Medicine)
Office visit for an established patient with frequent intermittent, moderate to severe headaches requiring beta blocker or tricyclic antidepressant prophylaxis, as well as four symptomatic treatment, but who is still experiencing headaches at a frequency of several times a month that are unresponsive to treatment. (Pain Medicine)
Office visit for an established patient with psoriasis with extensive involvement of scalp, trunk, palms, and soles with joint pain, Combination of topical and systemic treatments discussed and instituted. (Dermatology)
Office visit for a 55-year-old male, established patient, with increasing night pain, limp, and progressive varus of both knees. (Orthopaedic Surgery)
Follow-up visit for a 15-year-old withdrawn patient with four-year-old history of papulocystic acne of the face, chest, and back with early scarring and poor response to past treatment, Discussion of use of systemic medication. (Dermatology)
Office visit for a 28-year-old male, established patient, with regional enteritis, diarrhea, and low-grade fever. (Internal Medicine)
Office visit for a 25-year-old female, established patient, following recent arthrogram and MR imaging for TMJ pain. (Oral & Maxillofacial Surgery)
Office visit for a 32-year-old female, established patient, with large obstructing stone in left mid-ureter, to discuss management options including urethroscopy with extraction or ESWL. (Urology)
Evaluation for a 28-year-old male, established patient, with new onset of low back pain. (Anesthesiology/pain Medicine)
Office visit for a 28-year-old female, established patient, with right lower quadrant abdominal pain, fever, and anorexia. (Internal Medicine/Family Medicine)
Office visit for a 45-year-old male, established patient, four months follow-up of L4-5 diskectomy with persistent incapacitating low back and leg pain. (Orthopadic Surgery)
Outpatient visit for a 77-year-old male, established patient, with hypertension, presenting with a three-months history of episodic substernal chest pain on exertion. (Cardiology)
Office visit for a 25-year-old female, established patient, for evaluation of progressive saddle nose deformity of unknown etiology. (Plastic Surgery)
Office visit for a 65-year-old male, established patient, with BPH and severe bladder outlet obstruction, to discuss management options such as TURP. (Urology)
Office visit for an adult diabetic established patient with a past history of recurrent sinusitis who presents with one-week history of double vision. (Otolaryngology/Head & Neck Surgery)
Office visit for an established patient with lichen planus and 60% of the cutaneous surface involved, not responsive to systemic steroids, as well as developing symptoms of progressive heartburn and paranoid ideation. (Dermatology)
Office visit for a 52-year-old male, established patient, with a 12-year-old history of bipolar disorder responding to lithium carbonate and brief psychotherapy, Psychotherapy and prescription provided. (Psychiatry)
Office visit for a 63-year-old female, established patient, with history of familial polyposis, status post-colectomy with sphincter sparing procedure, who now presents with rectal bleeding and increase in stooling frequency. (General Surgery)
Office visit for a 68-year-old male, established patient, with the sudden onset of multiple flashes and floaters in the right eye due to a posterior vitreous detachment.(Ophthalmology)
Office visit for a 55-year-old female, established patient, on cyclosporine for treatment of resistant, small vessel vasculitis. (Rheumatology)
Follow-up office visit for a 55 year-old male, two months after iliac angioplasty with new onset of contralateral extremity claudication. (Interventional Radiology)
Office visit for a 68-year-old male, established patient, with stable angina, two months post myocardial infarction, who is not tolerating one of his medications. (Cardiology)
Weekly office visit for 5FU therapy for an ambulatory established patient with metastatic colon cancer and increasing shortness of breath. (Hematology/Oncology)
Follow-up office visit for a 60-year-old male, established patient, whose post-traumatic seizures have disappeared on medication and who now raises the question of stopping the medication (Neurology)
Office evaluation on new onset RLQ pain in a 32-year-old female, established patient. (Urology/General Surgery/Internal Medicine/Family Medicine)
Office evaluation of 29-year-old, established patient, with regional enteritis, diarrhea, and low-grade fever. (Family Medicine/Internal Medicine)
Office visit with 50-year-old female, established patient, diabetic, blood suger controlled by diet, She now complains of frequency of urination and weight loss, blood suger of 320 and negative ketones on dipstick. (Internal Medicine)
Follow-up office visit for a 45-year-old, established patient, with rheumatoid arthritis on gold, methotrexate, or immunosuppressive therapy. (Rheumatology)
Office visit for a 60-year-old male, established patient, two years post-removal of intracranial meningioma, now with new headaches and visual disturbance.(Neurosurgery)
Office visit for a 68-year-old female, established patient, for routine review and follow-up of non-insulin dependent diabetes, obesity, hypertension, and congestive heart failure, Complains of vision difficulties and admits dietary noncompliance, Patient is counseled concerning diet and current medications adjusted. (Family Medicine)
99214 vs 99215
My provider asked me to run a report of E/M’s billed (99213-99215) over the past two months; mostly out of curiosity. Our 99215 visits are very low and he’s thinking that some of his level 4’s could have been level 5’s based on the complexity of his patients. I’ve read over the requirements in the CPT book and skimmed over the lengthy E/M guidelines from CMS, however, I’m wondering if any of you can provide me with a link to a document/table that I can show him to make it easier to reference to. I’ve been looking and haven’t had great luck. I may make my own but was hoping someone might have a good starting point for me. (I’m a fairly new biller) Main interest is comparison between 99214 vs 99215.
Also, when does time come into play? I know 99215 states 40min; need some guidance on whether or not that needs to be documented in the note if he bills based on MDM vs time.
I appreciate your time very much!!!
99214 and 94640 unbundled documentation
Please help!! I know this has been covered in the forum previously but i am only pulling up old stuff and want to make sure i have the most current information on this. Thanks in advance!
99214, 99406, 90472, 96372
Can someone please explain to me how to bill for the following on the same day.
99214
99406
90472
96372
When I append the 25 modifier, I get the following:
The Diagnosis Code(s) submitted with the Procedure Code (99406) does not meet or may not fully support Medical Necessity.
Code 99406 is a component of code 90472 but a modifier is allowed on 99406.
The Procedure Code (90472) is defined as an add-on code.
The Procedure Code (90472) is invalid or requires a parent that is not on the claim.
The patient is in his 40s so I’m confused what the last line means.
Thank you again!
99213 versus 99214
75 year old female who is 1.5 weeks post-op from aortic valve replacement (TAVR), with history of peripheral neuropathy, multiple spinal surgeries, Addison’s disease, atrial fibrillation s/p AICD/pacemaker on warfarin, CAD here for left leg pain and increased swelling.
*
Leg swelling.
– INR 1.3
-no lightheadedness/dizziness
– has had palpitations the last few days; had them most recently this am.
-feels like she is getting adequate air; no shortness of breath
-no chest pain
-left leg swelling from knee down worse than usual
-new pain in her calf that is different from her neuropathic pain.
-neuropathy in both feet, unable to tell whether there is pain or tingling
– no history of DVT or PE that she can recall.
– she does not believe that she was on heparin or lovenox in hospital. She is very worried about an allergic reaction if she were to start a new medication today.
*
Dr. Siwek’s note says: "Coumadin was started for possible valve leaflet thrombosis. Did not improve gradient – hence TAVR. Probably not unreasonable to continue initially post TAVR but indication/duration a little unclear."
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*
Review of Systems
Constitutional: Negative for chills and fever.
Respiratory: Negative for cough, shortness of breath and wheezing.
Cardiovascular: Positive for palpitations and leg swelling (left leg). Negative for chest pain, orthopnea and PND.
Gastrointestinal: Positive for nausea. Negative for constipation, diarrhea and vomiting.
Genitourinary: Negative for dysuria and urgency.
Skin: Negative for rash.
Neurological: Negative for dizziness and headaches.
*
*
Patient Active Problem List
Diagnosis
Chronic adrenal insufficiency (HCC-CMS)
GERD (gastroesophageal reflux disease)
Vaginal prolapse
Psoriasis
Atrial fibrillation (HCC-CMS)
Pacemaker
Breast cancer screening
Pernicious anemia
Mitral valve insufficiency and aortic valve insufficiency
Mixed hyperlipidemia
Peripheral vascular disease, unspecified (HCC-CMS)
Coronary artery disease with angina pectoris with documented spasm (HCC-CMS)
Colon cancer screening
Essential hypertension
Controlled substance agreement signed, pending scanned documents
Fusion of spine of thoracolumbar, multilevel fixation screws, hx revision fo broken hardware
Other osteoporosis without current pathological fracture
Chronic obstructive pulmonary disease (HCC)
Proctitis
Gout
Allergic rhinitis
Chronic pain of multiple sites
Hypertrophic cardiomyopathy (HCC-CMS)
Chronic pain of right knee
Opioid dependence on agonist therapy (HCC-CMS)
Pulmonary hypertension (HCC-CMS)
Ulcer of great toe (HCC-CMS)
Physician orders for life-sustaining treatment (POLST) form indicates patient wish for full code resuscitation status
*
Past*Medical*History
Past Medical History:
Diagnosis Date
Addison disease (HCC-CMS) *
Asthma *
Cataract *
DJD (degenerative joint disease) *
Fibromyalgia *
GERD (gastroesophageal reflux disease) *
HTN (hypertension) *
Hypercholesterolemia *
Mammary dysplasia *
Pap smear 12-29-05
* normal
Psoriasis *
PUD (peptic ulcer disease) *
PVD (peripheral vascular disease) (HCC-CMS) *
Rhinitis, allergic *
Tobacco use disorder *
Vaginal prolapse *
Valvular heart disease 8/29/2015
* 11/2012 s/p tissue mitral and aortic valve replacement b Dr Siwek. Severe MR with hypertrophic cardiomyopathy, mild aortic stenosis.
*
*
Past*Surgical*History
Past Surgical History:
Procedure Laterality Date
APPENDECTOMY; * *
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING, ARTICULAR CARTILAGE (CHONDROPLASTY) * *
* benign bone tumer removed
COLONOSCOPY * 10-29-12
* Dr.Rose
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DX, W/WO SPECIMENS/COLON DECOMP (SEP PROC) * 7/28/16
* Colonoscopy
CORONARY ART/GRFT ANGIO S&I * 8/4/15
* Coronary cath/angio
DOPPLER ECHOCARDIOGRAPHY; COMPLETE * 7/2016
* LVEF low normal, 50-55%. Pacer/defibrillator present, bioprosthetic MV present and appears to be functioning normally. Trace MR, mild TR. PA pressure 47mmHg. Bioprosthetic aortic valve appears to be functioning normally.
EMBOLECTOMY/THROMBECTOMY; FEMOROPOPLITEAL/AORTOILIAC ARTERY, LEG INCISION * 6/30/15
* Left common & deep femoral artery thrombectomy, left iliofemoral embolectomy, patch angioplasty of left common & deep femoral artery placment of left external iliac artery, Left 6/30/15
EXTREMITY STUDY * 8/4/15
* Left LE US negative for DVT
FEM/POPL REVAS W/ATHER * *
HEMIARTHROPLASTY, HIP, PARTIAL * *
* L total hip followed by reattachment of muscle following surgery
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTOMY, 1/2 SEGMENTS; LUMBAR * *
* Laminectomy, Lumbar 13 back surgeries
NEUROPLASTY &/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL * *
* bilateral carpal tunnel
OOPHORECTOMY, PARTIAL/TOTAL, UNILAT/BILAT * *
* bilateral
REPAIR ARTERIAL BLOCKAGE * 11/11/15
* SUCCESSFUL PTA OF L COMMON FEMORAL ARTERY WITH DRUG COATED BALLOON
UNLISTED PROC, FOOT/TOES * *
* toe surgery by Dr. Clarke after shovel injured her toe.
UNLISTED PROC, LEG/ANKLE * *
* "ankle surgery"
UNLISTED PROC, SPINE * *
* thoracolumbar fixation hardware
VAGINAL HYSTERECTOMY, UTERUS >250 GMS; * *
*
Social*History
Social History
*
Social History
Marital status: Single
* * Spouse name: N/A
Number of children: 5
Years of education: 14
*
Occupational History
Not on file.
*
Social History Main Topics
Smoking status: Former Smoker
* * Quit date: 12/11/2008
Smokeless tobacco: Never Used
Alcohol use No
Drug use: No
Sexual activity: Not on file
*
Other Topics Concern
Not on file
*
Social History Narrative
* Lives alone, her daughter lives a block from her
*
*
*
Current Outpatient Prescriptions
Medication Sig Dispense Refill
metoclopramide HCl (REGLAN) 10 mg tablet Take 1 Tab by mouth 4 (four) times daily before meals and nightly 120 Tab 3
polymyxin B sulf-trimethoprim (POLYTRIM) 10,000 unit- 1 mg/mL ophthalmic solution Place 1 Drop into the right eye 4 (four) times daily 10 mL 0
promethazine (PHENERGAN) 25 mg tablet TAKE 1 TABLET BY MOUTH EVERY 8 HOURS AS NEEDED FOR NAUSEA. 30 Tab 0
promethazine (PHENERGAN) 25 mg tablet TAKE 1 TABLET BY MOUTH EVERY 8 (EIGHT) HOURS AS NEEDED FOR NAUSEA 30 Tab 5
buprenorphine-naloxone (SUBOXONE) 8-2 mg SL tablet DISSOLVE 1/2 TABLET UNDER THE TONGUE 3 TIMES A DAY. 42 Tab 0
predniSONE (DELTASONE) 5 mg tablet Take 2 Tabs by mouth once daily 90 Tab 3
ondansetron HCl (ZOFRAN) 4 mg tablet TAKE 1 TABLET BY MOUTH EVERY 4 HOURS AS NEEDED FOR NAUSEA. 60 Tab 3
allopurinol (ZYLOPRIM) 300 mg tablet Take 1 Tab by mouth once daily 30 Tab 5
gabapentin (NEURONTIN) 600 mg tablet Take 1 Tab by mouth 2 (two) times daily 180 Tab 6
ergocalciferol, vitamin D2, (VITAMIN D2) 50,000 unit capsule Take 1 Cap by mouth once a week 12 Cap 3
PNV,calcium 72-iron-folic acid 27 mg iron- 1 mg tab Take 1 Tab by mouth once daily * *
fluticasone (FLONASE) 50 mcg/actuation nasal spray Place 2 Sprays into the nostril(s) once daily 16 g 11
carvedilol (COREG) 6.25 mg tablet Take 1 Tab by mouth 2 (two) times daily with a meal * *
alirocumab 75 mg/mL pnij Inject 75 mg into the skin every 14 (fourteen) days. * *
cyclobenzaprine (FLEXERIL) 10 mg tablet TAKE ONE TABLET BY MOUTH THREE TIMES DAILY AS NEEDED FOR MUSCLE SPASMS 30 Tab 5
meclizine (BONINE) 25 mg tablet Take 25 mg by mouth 2 (two) times daily as needed. * *
ENTERIC COATED ASPIRIN 81 MG TAB, DELAYED RELEASE 1T PO QD 30 Tab 11
*
No current facility-administered medications for this visit.
*
*
Objective
*
Vitals
Vitals:
* 09/17/18 1000
BP: 134/65
Pulse: 79
Resp: 16
Temp: 97.8 °F (36.6 °C)
TempSrc: Oral
SpO2: 95%
Weight: 139 lb (63 kg)
Height: 5′ 1" (1.549 m)
Last 3 Vitals
Office Visit from 9/17/2018 in Winding Waters Medical Clinic Office Visit from 9/13/2018 in WW JOSEPH MEDICAL CLINIC Office Visit from 8/16/2018 in WW JOSEPH MEDICAL CLINIC
Temp 97.8 °F (36.6 °C) 97.8 °F (36.6 °C) 97.5 °F (36.4 °C)
Pulse 79 85 85
BP 134/65 106/56 115/73
Resp 16 16 20
Weight 139 lb (63 kg) 141 lb (64 kg) 139 lb (63 kg)
*
Estimated body mass index is 26.26 kg/m² as calculated from the following:
Height as of this encounter: 5′ 1" (1.549 m).
Weight as of this encounter: 139 lb (63 kg).
Facility age limit for growth percentiles is 20 years.
*
Physical Exam
Constitutional: She is oriented to person, place, and time. No distress.
Pale elderly female
HENT:
Head: Normocephalic and atraumatic.
Right Ear: External ear normal.
Left Ear: External ear normal.
Nose: Nose normal.
Eyes: Pupils are equal, round, and reactive to light. Conjunctivae and EOM are normal. Right eye exhibits no discharge. Left eye exhibits no discharge. No scleral icterus.
Neck: Normal range of motion. Neck supple. No thyromegaly present.
Cardiovascular: Normal rate and regular rhythm.
No murmur heard.
2+ femoral pulses bilaterally. Unable to palpate DP or tibialis posterior pulses
Pulmonary/Chest: Effort normal and breath sounds normal. No respiratory distress.
Abdominal: Bowel sounds are normal. She exhibits no distension and no mass. There is no tenderness.
Musculoskeletal: She exhibits edema.
1+ pitting pedal edema bilaterally
Lymphadenopathy:
She has no cervical adenopathy.
Neurological: She is alert and oriented to person, place, and time. No cranial nerve deficit.
Skin: Skin is warm and dry. She is not diaphoretic. No pallor.
Psychiatric: She has a normal mood and affect. Her behavior is normal.
*
*
Assessment and Plan: 75 year old female who is 1.5 weeks post-op from aortic valve replacement (TAVR), with history of multiple spinal surgeries, Addison’s disease, atrial fibrillation s/p AICD/pacemaker on warfarin, CAD here for left leg pain and increased swelling. Given recent surgery and subtherapeutic INR, there is concern for DVT/PE. However, patient’s leg swelling is relatively unimpressive with no erythema, warmth, collateral veins or significant enlargement compared to other side. I reviewed discharge summary and records from her recent hospitalization. Per her thoracic surgeon, unclear benefit of warfarin in this situation, and duration of therapy also unclear. No shortness of breath now and VS are within normal limits, making pulmonary embolism less likely, but she has had palpitations last 2 days. Other etiologies of palpitations could be cardiac arrhythmia such as rapid atrial fibrillation, dehydration, anxiety. None of these are apparent today.
– LLE duplex now.
– shared decision making around CTPA – patient declines at this time and I think this is reasonable – see above.
– will rx lovenox if US shows DVT.
– strict return precautions given – see instructions.
*
R60.0 Edema of left lower extremity (primary encounter diagnosis)
Plan : US STUDY FOLLOW-UP (SPECIFY) (Future)
US STUDY FOLLOW-UP (SPECIFY)
*
I48.91 Atrial fibrillation, unspecified type (HCC-CMS)
Plan : INR COAGUCHEK (POCT)
INR 1.3 today. Plan to increase warfarin dosing to 10 mg on Monday and Friday and 5 mg the rest of the week. Recheck Friday 9/21/2018
*
M79.605 Left leg pain
Likely explained by peripheral neuropathy. Continue gabapentin. Will monitor.
*
Total of 20 minutes was spent with the patient. Greater than 50% of time was spent in FTF counseling and coordination of care for the above diagnoses.
*
Cpt 99214
I am a little confuse on using CPT 99214. When my provider sees a patient for sore throat, fever, and we do a rapid strep test, and influenza A&B, one is positive. So Antibiotics are prescribe, does this warrant CPT 99214. Because he prescribe antibiotics, and tested for two distinct test.