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Last 10 Posts (In reverse order)
courtneydsnow Posted: Wednesday, March 1, 2017 2:26:14 PM(UTC)
 
Hi Eastland Dental Center!

Great questions. Yes 99242 can be used when a patient is directly referred from another healthcare professional. Using this group of Evaluation & Management (E&M) codes, known as "consultation" E&M codes, 99241-99245 does require the direct referral as well as a letter back to the referring health professional. However, Medicare stopped accepting these codes back in 2010, so some private insurers no longer accept them either.

In general, the "consultation" E&M coding set 99241-99245 does have a bit higher allowed amounts than the "new patient" E&M coding set 99201-99205.

When it comes to the documentation requirements vs. time spent for E&M coding, most practices go by documentation requirements, which for each level of code (1-5) requires a certain level of history taken from the patient, a certain level of exam performed by the doctor, and a certain level of medical decision making.
If you are using time spent as the key factor for selecting the level of E&M code, yes you always want to make sure that you record the amount of time the patient spent face to face between the patient & doctor, and that at least 50% of that time was spent counseling the patient (and also important to note what was discussed during the time spent counseling).


Here is the break-down of the required documentation for the different levels & types of visits:

New Patient Codes (not referred)

99201
• 10 min face to face w/ doc - Presenting problems are self-limited or minor
Or
• A problem focused history
• A problem focused exam
• Straightforward medical decision making

99202
• 20 min face to face w/ doc – Presenting problems are low to moderate severity
Or
• An expanded problem focused history
• An expanded problem focused exam
• Straight forward medical decision making

99203
• 30 min face to face w/ doc – Presenting problems are moderate severity
Or
• A detailed history
• A detailed exam
• Low complexity medical decision making

99204
• 45 min face to face w/ doc - Presenting problems are moderate to high severity
Or
• A comprehensive history
• A comprehensive exam
• Moderate complexity medical decision making

99205
• 60 min face to face w/ doc 0 Presenting problems are moderate to high severity
Or
• A comprehensive history
• A comprehensive exam
• High complexity medical decision making


Established Patient Codes:

99211
• Visit may not require presence of doc, typically 5 min spent with patient
Or
• Do your SOAP notes!

99212
• 10 min face to face w/ doc - Presenting problems are self-limited to minor
Or
• A problem focused history
• A problem focused exam
• Straightforward medical decision making

99213
• 15 min face to face w/ doc - Presenting problems are low to moderate severity
Or
• An expanded problem focused history
• An expanded problem focused exam
• Low complexity medical decision making

99214
• 25 min face to face w/ doc - Presenting problems are moderate to high severity
Or
• A detailed history
• A detailed exam
• Moderate complexity medical decision making

99215
• 40 min face to face w/ doc - Presenting problems are moderate to high severity
Or
• A comprehensive history
• A comprehensive exam
• High complexity medical decision making


Consultation Codes (patient’s referred directly from other health providers)
Special note on this set of E&M codes:

• requires follow up letter to referring health professional
• some companies no longer accept these codes, only new & established codes


99241
• 15 min face to face w/ doc - Presenting problems are self-limited or minor.
Or
• A problem focused history
• A problem focused exam
• Straightforward medical decision making

99242
• 30 min face to face w/ doc - Presenting problems are low severity
Or
• An expanded problem focused history
• An expanded problem focused exam
• Straightforward medical decision making

99243
• 40 min face to face w/ doc - Presenting problems are moderate severity
Or
• A detailed history
• A detailed exam
• Low complexity medical decision making

99244
• 60 min face to face w/ doc - Presenting problems are moderate to high severity
Or
• A comprehensive history
• A comprehensive exam
• Moderate complexity medical decision making

99245
• 80 min face to face w/ doc - Presenting problems are moderate to high severity
Or
• A comprehensive history
• A comprehensive exam
• High complexity medical decision making


To learn more about E&M coding in medical billing, watch our recorded Tuesday evening study group over E&M coding! You can follow the link below, or visit the DentalWriter Help Center to watch the recording at any time!
http://www.screencast.com/users/DentalWriterStarter/folders/Study%20Group%20Recorded%20Session/media/2f53bbe2-bb2e-478b-921a-a019ee99eee5

Hope this helps, have a great day!
eastland dental center Posted: Tuesday, February 28, 2017 2:27:07 PM(UTC)
 
Hello,

Do you recommend using a consultation code (99242) for the initial visit when a patient is referred from a sleep doctor or primary care physician for evaluation and treatment for an oral appliance for obstructive sleep apnea? Or is reimbursement higher using a new patient code (99202)?

We have been attaching SOAP notes to the medical claim form, do we also need to list on the claim form how much time is spent with the patient? If so, where do you put in the time spent on the claim form?

Thank you!