E/M and lap band adjustments help!

Coder-To-Coder Forum

E/M and lap band adjustments help!

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codingnut15 01-03-2010, 2:01 PM
If pt comes in following lap band surgery (out of global period) due to over or under restriction, and the patient is a Medicare patient, is billing out 99213 appropriate?

For instance, HPI has 1-3/ROS-problem pertient and/or exam has 2-4 items. It was then decided due to patient's symptoms that an adjustment would be required.

Since Medicare does not pay for these adjustments, is the MDM correct or should it be 99214?

Thanks for your help.

Re: E/M and lap band adjustments help!

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Barb S. 01-07-2010, 9:03 AM

99213 is appropriate based on the information you indicated.

You need two out of three levels for an Established patient visit... if you have an Expanded HPI, a Prob. Pert. Exam, and a Moderate or High MDM ...you are still at 99213 level or service.

To bill the 99214 you'd need a HPI or Exam level at Detailed. to add to the Moderate or High MDM. You are not indicating you have documentation to support a Detailed level of HPI or Exam....so, 99213 is the best you can do with the documentation you have.