We've had several good questions come back to us over the past month and I would like to share some of them with you. Here goes:
Question
I was in a review course that was being given by a Medicare education team and the teacher was saying that if you pick the 1995 exam criteria, your whole exam and history has to be that year's rule i.e., for the HPI the 95 rules say you have to use 4 element of HPI for a level 4 visit, you CAN NOT use the status of 3-4 diseases for level 4 visit, because that is the 97 rule. If you pick the status of 3 chronic diseases you have to do the 97 physical with the bullets. Please let me know which is the case.
Answer
It is correct that you must use either the 1995 or 1997 guidelines. Not both. Over the past 2-3 years I have tried to emphasize for a level 4 history to not really ever use the status of 3 diseases. Rather, I try to focus on exacerbation, progression, and side effects for each disease. For example:
Patient is here for f/u of HTN. Last seen 3 months ago. Taking Diovan. No side effects reported. BP has been 130's/90's at home. Denies any new cardiovascular or respiratory symptoms.
This gives you 4 elements of HPI:
Plus it also gives you Past Medical History (problem list/med list) And also included 2 areas of ROS (cardiovascular and respiratory) We also mentioned that this is a moderate risk patient (chronic problem with mild exacerbation)
Starting last year I began to encouraged people to do their notes more along this line. This year we really focus on this new format in the conference because I found it helps eliminate any problems/discrepancies when you are audited.
Question:
Situation: For an office visit (E/M) where our provider performed an associated office procedure. In billing the visit, what modifier should I use and where shall it be under...... should it be under the E/M code or the procedure code?
Answer:
There is no good consensus. Some would say put the -25 on the E&M service. Others would say put the -59 on the procedure. If you do one of these, make sure and list the code without the modifier before you list the code with the modifier. Some coders would say put both modifiers on it.
Try it one way and if it doesn't work, try it differently. Typically I would put the primary reason they came today as the first code with no modifier. Then list the secondary code with the modifier next.
For example, if they were here for an office visit and I did a tympanometry, then I would bill it is a 99213 with no modifier and a 92567-59. If they were here to freeze off warts, then also had a URI that they had questions about, then I would bill 17110 with no modifier and then 99213-25.