Coding > Coding
Coding 99214 vs 99213 for a sick visit
DMK:
I see your point, and understand the concern. However, considering the uptick in whooping cough, he was probably doing his due diligence to make certain the "cough" wasn't something more serious. For adult care, we probably know if we're sick or REALLY sick so you could better determine 99213 or 99214.
rgcolumbus:
Well, I sat down with the coder and she went through several scenarios. Basically, there are certain history items they always ask. The number of items classifies the history as detailed. The exam is always comprehensive since they are dealing with pediatric care and they don't want to miss something. Since these two meet the guidelines for 99214, I pretty much have to accept that they will always be billing this.
I would love to see some statistics for pediatric care and how often each code is used. This would give me a better understanding if I am being treated fairly.
RichardP:
Maam, you are the parent. You know your child. You state that it is only a cough. Yet you take the child to the doctor. The doctor knows what I just stated. The doctor knows you wouldn't be in his office if you were convinced it was just a cough. The doctor thinks the same thing you are thinking - is this something more than just a cough? You are not paying to get the cough treated. You are paying for the assurance that it is nothing more than just a cough.
Determining that a cough is indeed just a cough may be simple. Determining that a cough is not something more than just a cough is more complex. That is why the higher coding and the higher charge.
rgcolumbus:
Thanks. So if that is what a typical 99214 visit looks like, what does a typical 99213 look like?
RichardP:
Assume the cough has been determined to be caused by nothing more than post-nasal drip. Child is an established patient. You take child back to doctor because he is getting a sore throat from coughing. Doctor verifies that throat is sore and suggest some course of action to address the sore throat. Will likely request to see the child in the near future to verify that the sore throat is getting better and not worse.
If you want to educate yourself a bit, you might check out these links. If you are really curious, check out the home page as well.
http://emuniversity.com/Level3EstablishedOfficePatient.html
http://emuniversity.com/ClinicialExample99213.html
http://emuniversity.com/Page7.html
http://emuniversity.com/index.html
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