When I started out to code patient chart’s for established patient’s vists, I didn’t know what I was doing nor how to start.  A lot of searches on the web turned up a few really good articles. Here are the ones that stuck out the most to me:

The last one is the absolute BEST even though it was written in 2003.  (I hate the article name. To me it implies a shady practice methodology. Thus, I will refer to this article as “Documenting 99214 Procedures”.) It is written for in-office/facility visits.  It also has a great table to help you make sense of the patient’s visit when reading only the patient chart. Take the time to go read this article first.  I hope you will return to read the rest of mine afterwards.

The rest of this article will build on the table in “Documenting 99214 Procedures” but with a few modifications for Home Health:

CPT Code 99347 99348 99349 99350
New Patient CPT Code 99342 99343 99344 99345
Level I II III IV
Alternate Level Name N/A Recheck Intermediate Reassessment
HISTORY
  CC Required Required Required Required
  HPI 1-3 Elements 1-3 Elements

(or 3+ chronic diseases)

4+ Elements

(or 3+ chronic diseases)

  ROS N/A Pertinent 2-9 Systems 10+ Systems
  PMH, FH, SH N/A N/A 1 History Area 2+ History Areas
EXAMINATION

Guidelines

1-5 Elements

Expanded Problem Focused Examination:

6-11 Elements

Detailed Examination:

12 or more Elements

Comprehensive Examination

Guidelines

System of Complaint 2-4 Systems 5-7 Systems 8+ Systems
MEDICAL DECISION MAKING
Straightforward Low Complexity Moderate Complexity High Complexity
TIME
15 Minutes 25 Minutes 40 Minutes 60 Minutes
PAYMENT RATE
  2012 History Payment $54.68 $82.38 $123.80 $171.86
  2013 Dr’s Payment $54.65 $82.69 $125.48 $174.20
  2013 NP’s Payment $46.45 $70.29 $106.66 $148.07
2010 CLAIM FREQUENCY
10% 25% 43% 21%

CPT Code – Each code in the table links to the AMA website which has the full description for that column. NOTE: When the AMA website refers to “2 of 3 components,” they are talking about the components “HISTORY”, “EXAMINATION”, and/or “MEDICAL DECISION MAKING.”

Level – Listening to medical people, they use the term “Level I/II/III/IV” to describe their meeting with the patient.  No where could I confirm that this is an “official” category.  However, a friend’s Superbill showed how they equated a Level to a CPT code. Thus, I provided it on my table.

Alternate Level Name – I put this in because we see this on our current Patient Encounter form that we are using.  The company where we got the form is no longer in business.  However, it is interesting to note that they NEVER billed a CPT code of 99347.  They just left that option off the form.

 

HISTORY component from our Patient Encounter form

The biggest problem we have is that the PFSH is it not being filled out.  It is easy to identify on the form above when CC, HPI, and ROS are completed.  However, when none or 1 of these History Areas are completed, that leaves some question as to whether the whole History is usable as “2 of these 3 key components.”  By completing 1 or 2 History Areas, it makes it easy to see that the component called “History” is complete and qualifies for 99349 or 99350!

 

EXAMINATION component from our Patient Encounter form

Fortunately for us, most all Examination elements are filled out during the patient visit. When an element is not handled, our physicians write “Deferred” which makes it easy to see that our component called “Examination” does/doesn’t qualify for 99349 or 99350.

 

MEDICAL DECISION MAKING component from our Patient Encounter form

Our form does not make it easy to tell which level the patient visit qualifies for.  The CMS Evaluation and Management Services Guide devotes pages 83 through 87 to this topic.  They do not make it easy to understand whether you are an untrained medical person or a physician; instead, I often defer back to the physician and the “Level” they perceive the patient visit to be.  I’ve found that most physicians instinctively know the level of Medical Decision Making for the visit.  Thus, on my form, I refer to the Alternate Level Name; you may want to defer this decision to the Level specified by your physicians to determine for which CPT Code the component called “Medical Decision Making” qualifies.

The TIME factor is just a guideline.  It is not a hard and fast rule.  Just because your patient visit lasted 45 minutes does not mean you can bill for CPT Code 99349.  However, the “Documenting 99214 Procedures” article implies that spending 45 minutes face-to-face with the patient WILL get you an indisputable CPT Code 99349. Note: Our Patient Encounter form does not collect time.

The 2012 PAYMENT RATE must be entered into the billing system before submission to Medicare.  Therefore, this line was added by me just to keep me from having to look up the amount on the AMA website.

The 2010 CLAIM FREQUENCY was added by me so I would know if my average submissions are relatively inline with history.  I suspect that if your company commonly bills 10% 99348, 70% 99349, and 20% 99350, you may standout for audits… If audit’s are conducted.

NOTE: I am not a license physician. I know nothing about medical procedures. I know nothing about the legalities of the medical profession. I am not a trained coder. I’ve just been thrown into this position due to my current job situation and this post describes the primary table I use to do my job.

PLEASE: If you see something that is obviously wrong, write me! If you have a better system for identifying the appropriate CPT Code to bill for, write me.

Rob Stokes

The original post is located at: http://blog.rdstokes.com/?p=81