Coding (Medicaid Charges)
(as of 9/6/00)
Introduction: I have found that coding is somewhat of an
art form it keeps changing and as soon as you discover one way to do it,
impediments crop up.
Outpatient Charges:
1. Sick Visit: Residents will be asked to fill out the
following documentation on the sick visit forms: code of charge, and
diagnosis. The attending will fill in the doctor number and sign the form:
99211: Minimal No MD this is for nurses only. If you see the
patient, do not choose this alternative.
99212: Problem focused: time spent: 10 minutes in doing two of the
following three key components: a problem-focused history, a
problem-focused examination and straightforward decision-making.
99213: Requires 2 of three components in a 15 minute interaction:
expanded problem-focused history; an expanded focused examination; and a
medical decision- making of low complexity.
99214: Requires 2 of the following 3 components: a detailed history; a
detailed examination; and medical decision-making of moderate
complexity. This might take 25 minutes with the family.
99215: Requires 2 of 3: comprehensive history; comprehensive
examination; and medical decision making of high complexity. May take up
to 40 minutes.
Documentation is key! Must indicate what your thought processes were,
particularly if charging 99214 or 99215 levels. In general, when CBC and
blood or urine cultures are drawn in a sick child, that will be at least a
99214 although 99215 can be considered. If admitted to the general service,
we do not get paid twice so must choose who charges.
Resident Only Sick Visit: If attending does not see the
patient with the resident in continuity clinic, charges can still be made,
but not more than the 99213 code.
2. Well Child Visit (EPDST) Charges are allowed for: Under
10 days: this form should be used for the returning breast fed child, or any
child seen after delivery in this age group. 2 weeks, 2 month, 4 month, 6
month, 9 month, 12 month 15 month, 18 month. Children should be scheduled
for these health assessment examinations even if they dont need shots. All
aspects of health assessment should be performed.
If another condition is treated, referred, under treatment, then an
additional charge can be made: ONLY 99212: Problem-focused or limited. If
you check off 99213 or 99214, then the fee from the well child visit ($55)
will be forfeited and you will be reimbursed only the lower amount.
Procedures: Procedures such as cerumen removal (impaction),
silver nitrate cauterization should be charged. They are listed on the sick
form, but must be added to EPDST form.
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