Billing Strep Throat
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How did you code it?
Are you surprised at the answer? We checked this with our coding experts to make sure it was correct, and it is.
Here is why....
- This is an established patient. The bar is lower to bill at a level 4 with an established patient.
- It had a Chief Complaint. Did you know you can't bill for ANY visit if you don't include the CC?
- It had 5 elements in the HPI. You only need 4 HPI elements to bill at a 4.
HPI: He has had sore throat for 2 days, fever to 101.5F, worse with swallowing, severe enough to make him cry.
1. Location 2. Duration 3. Associated symptoms 4. Context 5. Severity
- It had 4 elements in the ROS. Only 2-9 elements are required to count as an extended (not complete) ROS.
- It had both PMH and SH. Even if they have no PMH, a simple statement that they have no PMH counts. But if you say "non-contributory" this does not count. Also, a brief word on SH that counts is who accompanies a minor or a comment on smoking history in adults.
- Next it had a physical exam that included head, EENT, constitutional/VS, respiratory, and CV. For a detailed exam, 2-7 systems must be documented.
- For medical decision making, this is a new problem with no additional workup planned; the presenting problem is minor, and it requires prescription drug management. This makes the medical decision making Moderate Complexity.
- The result of a detailed history + detailed exam + moderate complexity medical decision making = 99214. It only takes 2 out of the 3 elements to bill at a 99214.
What if this was a new patient?
If you did exactly the same history, exam, and medical decision making as above for a new patient, as opposed to an established patient, this would be a 99203.