EPSDT
Billing for maternal depression screen occurs at what age?
2, 4, and 6 months
What order must you place when doing a knee injection?
Arthrocentesis/Aspiration/Injection major joint - 20610
A patient known to you comes in for a physical exam with a pap smear
Established, preventative with 25 modifier and pap smear order
Patient comes in for sore throat, found to have strep pharyngitis and prescribed keflex
Level 3
How many categories do you need to bill a level 4?
- Number of complexity/problems addressed
- Amount of data to be reviewed
- Risk of complications
2 out of 3 categories
At what ages do developmental screening occur?
9, 18, and 30 months
What order do you place when doing a shave biopsy on the arm?
shaving lesion 0.5cm or less trunk/arms/legs
A patient comes in for preoperative clearance prior to their cataract surgery
Office visit consult, level 3
Patient comes in with uncontrolled diabetes, BG in office of 450. You start them on insulin, order labs, and make an appointment in 1 week
level 4
Number of chronic illnesses required to meet criteria for a level 4?
1 chronic with acute exacerbation
2 chronic that are stable
What diagnosis codes would you add for well child visit of an 11 year old who was diagnosed with obesity this visit?
well child with abnormal findings
pediatric obesity
Encounter for immunization
Screening for lipid disorder
Can you bill a procedure if a patient comes in with vaginal itching and you want to evaluate if they have a yeast infection in the office?
Yes, you can bill for a wet mount - 87210
Transitional care management, high risk
Patient comes in for management of HTN and asthma. HTN is stable, and you refill losartan. Asthma is controlled on albuterol alone. You had ordered a BMP which you reviewed with them in the office (wnl)
Level 3
Time requirement to bill a level 4
30 minutes (established), 45 minutes (new) - time by attending in room
Autism screening
What order must you place when performing irrigation of ears for bilateral cerumen impaction?
Removal of cerumen impaction, 50
A patient comes in for nexplanon removal and replacement
Procedure code only, nexplanon removal/insertion
Patient comes in for management of DM and asthma. You had ordered a BMP and A1c previously and review it in the visit. DM is controlled, you refill medication. Asthma is better controlled now and you review the recent pulmonologist visit. The patient's partner calls and says they are snoring at night, you order a sleep study
Level 4
(review notes, review labs, independent historian)
How would an undiagnosed or acute illness meet criteria for level 4?
If it is new with an uncertain prognosis or is acute with systemic symptoms
This is the billing code for well child with abnormal findings
z00.121
How would you bill for a patient coming in for a visit for hypertension and knee arthritis, who you do a knee injection on?
Level 4, 25 modifier, with knee injection order code
A patient comes in for preoperative clearance for hysterectomy due to fibroids and menorrhagia. Patient has diabetes, hypertension, and anemia
Office consult level 4
Patient comes into the office with leg pain and trouble breathing. SpO2 92%, HR 110. Sent to the ER and discovered to have a PE, admitted to inpatient.
Level 5
True or false, if you discussed management or test results with another physician on the day of the visit, that would meet criteria for level 4?
True