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Established Patients
New Patients
Modifiers and other tidbits
Decision Making
Advanced coding
100
Must have ___ out of the three categories- history, exam, and medical decision making agree to code
What is two
100
Must have ___ out of the three categories- history, exam, and medical decision making agree to code
What is three
100
Which modifier is used anytime you charge a visit plus some sort of procedure
What is 25
100
This should guide your coding and is the most important piece to take into account
What is decision making
100
You're seeing someone back for a wart refreeze (you froze this 10 days ago)- what should you code? If they mention they have a cold and you evaluate that as well- what should you code?
What is 1. No e/m code- just the procedure code for wart freezing 2. Likely 99213, the procedure code for wart freezing, and a modifier 25.
200
The minimum elements needed to code a 99213
What is Brief HPI – 1-3 elements Pertinent ROS – 1 Don’t need PFSH 2-7 limited exam of body systems Low decision making
200
The majority of new patients visits are this code
What is 99203
200
Which modifier is used for bilateral procedures–i.e. knee injections, toenails
What is 50
200
Worsening problems count _____ New problems count _____
What is double, triple
200
You're seeing a 55 year old for his physical. He mentions that he has been having low back pain for several months, you evaluate that, determine that it's likely a strained muscle and prescribe muscle relaxants. What do you code?
What is CPE for 55 year old AND a 99213 for the low back pain - you associate v70.0 with the cpe code, and the lbp with the 99213 and use modifier 25.
300
Minimum documentation for a 99214
What is Extended HPI – 4 elements Extended ROS – 2-9 Pertinent PFSH - 1 2-7 extended exam of body systems Moderate decision making
300
What's the minimum you need to code a 99203
What is History- 4 HPI, 2 ROS, 1 component of PFSH Exam- 2 body systems Medical Decision Making- LOW
300
Commonly missed charges that can garner you a fair bit of money!
What is 1. Not marking Tobacco counseling $10 – 35 2. Not marking female exam / obtaining pap $30-60 3. Not coding or doing Dental Varnish or Comp Oral Eval. $50
300
What are examples of moderate risk things?
What is uncertain prognosis- i.e. lump in breast, abdominal pain, any prescription medication.
300
What is the best thing to code a skin lesion you are doing a biopsy of?
What is Neoplasm, skin, uncertain behavior
400
You see a patient for 2 problems - one new, and one stable chronic. You prescribe prescriptions medications. Assuming your history and exam match, what should code this based on the medical decision making
What is 99214
400
What's the minimum you need to code a 99204
What is History- 4 HPI, COMPLETE ROS (10+), COMPLETE PFSH Exam- 8+ organ systems Medical Decision Making- MODERATE
400
When billing based on time, what MUST you say
What is I spent ___ minutes with this patient, OVER HALF OF WHICH WAS SPENT COUNSELING about multiple medical problems, etc, etc.
400
2 things that you should make quick texts for because you do them frequently and they count for a point in data :
What is 1. Make a point of saying that you reviewed old records if you did 2. Make a point of saying you independently viewed images
400
For WCC is these charges are not included, typically medicaid will DENY the bill
What is hearing, vision, developmental screening at appropriate ages
500
66% of the time residents coded this, where as 36% of the time faculty coded this
What is 99213
500
Your new patient presents with no complaints- what's financially the best thing to code? What if they have one or 2 problems but also want to do a cpe?
What is 1. CPE for a new patient 2. Hard to split bill for a npv 99203 and CPE code - better off to do the 99203, and bring them back for the CPE (and assume that you are likely to split bill the second visit)
500
How many skin tags can you take off in one setting and how do you bill for it?
What is As many as you want - they are billed in increments of 15- so if you take off 1 or 14, you charge the same thing - however if you take off 16 - you can do the second skin tag charge (it's not quite double the money but does add up)
500
What are some common complaints that are easily coded a 99215? Bonus: what do you need to code a 99215 in history?
What is Chest Pain SOB Abdominal pain- especially if you're ordering scan, etc Neurologic complaints Bonus: 4 HPI, 10+ ROS, 2 PFSH
500
What's the best thing about coding?
What is It's how you get paid - if you do it well, you can see 16-20 people a day and make a decent living. Do it poorly and you can see 30 people and STRUGGLE.