BILLING CPT 99202 - When to use

Yesterday I mentioned the 99201 CPT E and M code. I said that it turns out most people over code the 99201 as a 99202. But I then thought, how would they know the difference and why would they over code.

Often overcoding is due to ignorance of what is required from each code. And frankly, to quote ex-president Clinton..........It depends on what the definition of Is, Is......

The same is true with words such as problem versus expanded problem.......

What does expanded problem mean? Expanded problem means that you took a problem relevant review of systems......my guess is that most of you do this, but often fail to document this. Review of Systems is super important here. In the 99201 you can get away without doing it in the HPI, but in the 99202 you cannot.

What is the 99202? A new patient which requires 3 components

1. An expanded problem focused history (Includes ROS)
2. An expanded problem focused exam
3. Straightforward medical decision making

So you may be asking yourself, "What is an expanded problem focused exam?"

A limited examination of the affected body area OR organ system affected AND other symptomatic or related organ systems

And now I hope you understand Straightforward Medical Decision Making......If not...

It is determined by:
1. The number of possible diagnoses if greater than 3 is usually complex....make sure you list differentials in your notes!!!
2. The amount of or complexity of medical records. labs, and other information that must be reviewed. Document ALL records reviewed in your notes.....
3. The risk of complications, morbidity and mortality associated with the problems, procedures and management options....

I hope you now see why cardiologists/surgeons/gastroenterologists get paid so much more than internists......EVERY SINGLE ONE OF THEIR CASES can be billed at higher levels of medical decision making.....

So, with that primer, let's see a 99202 in action.....

A 45 year old man is in with history and skin findings consistent with poison oak who is not responding to OTC treatment....

What is expected of you:
1. Preservice, review the medical history forms AND vital signs

2. Intraservice, Obtain the expanded problem history and physical, Formulate a diagnosis, formulate a treatment plan-Straight forward here-i.e. less than 3 differentials and simple treatment either way....Don't try and fudge this one...it is what it is....now reconcile your meds, write the Rx and test if you really need to...

3.  Document what you did, including listing dif Dx, care coordinate AND handle another treatment failure prn....

There, that wasn't so tough......Now how many of these do you see in a day....my guess is a whole lot more than you had thought about if you are new......if you are established, probably one to 2 a day at maximum.....

source modifer25.blogspot.com

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