I appreciate all the good comments and questions we've received over the past couple weeks of newsletters. Our first conference of the year will be in five short weeks. I hope to see many of you all there. We usually start off the year in Las Vegas and it is always a lot of fun. This year at Vegas we will be hosting an informal mixer after the conference. We envision this being an hour to relax and swap ideas and basically get to know our clients better. This should be a good time to meet and mingle outside of the conference.
Here's a great question from one of our newsletter subscribers:
My question is surrounding billing a 99215. Specifically, when assessing the risk associated with a presenting problem, Paul mentioned that "severe progression" of disease is one of the qualifying characteristics of a 99215. When seeing an established patient with multiple chronic illnesses, he gave examples of:
He suggested that ANY time a patient comes in with one of the above issues (even though their condition hasn't changed from visit to visit), and that issue was a part of the visit, that each and every time they come in, this patient has "severe progression" and should be coded a 99215 given that all the other criteria have been satisfied.
My question is: would a patient who has had an organ transplant be someone who is considered to have "severe progression" of a chronic illness? For example...a liver transplant for Hepatitis C....or a kidney transplant for Polycystic kidney disease/ or renal failure for any other reason. Does the fact that they now have a new organ make a difference?
Also, can you think of any other examples of severe progression of a chronic issue that might be encountered in a family practice that I could be on the lookout for?
Here are my thoughts:
If they have severe progression of disease, then anytime you see them for that disease then their level of risk would be High. Now in order to qualify for a 99215 you would still need the criteria for number of diagnoses/treatment plans, data review, history, and physical exam. If you meet the criteria for a 99215 and also have a high level of risk, I think most coders would have you submit a 99215.
Many organ transplant patients no longer meet the criteria for severe progression, because often they no longer have the same problems associated with the previous disease. For example, someone with liver failure would probably qualify as high risk. But if they have had a transplant and no longer have failure, I'm not sure that their risk would be high anymore unless that organ then proceeded to failure. If we look at progression as 'where they are in the process of their disease' then a transplant would usually move them backwards along that line to a less severe risk.
Hope this helps.