Code Decision Making Progressive Care Medical Group - Coding Worksheet HPI, History and ROS, PE Additional Notes Initial H&P Visits-SNF/NF - Requires Face to Face Visit 99304 Requires 1-2 Problem Points AND 1-2 Data Points (SF/L MDM)HPI: 4 elements OR Status of 3 Chronic Conditions Examples include: 1 self-limited acute problem plus 1 related chronic condition, PFSH: 1 of 3 ROS: 2-9 systems 1-2 established stable problems Exam: 6+ systems 99305 Requires 3 Problem Points AND 3 Data Points (M MDM)Examples HPI: 4 elements OR Status of 3 Chronic Conditions include: 1 or more chronic illnesses with exacerbation, 2 or more chronic PFSH: 3 of 3 ROS: 8+ systems illnesses with status included in HPI, undiagnosed new problem with uncertain Exam: 8+ systems prognosis (i.e. lump in breast) 99306 Requires 4 Problem Points AND 4 Data Points (H MDM)Examples HPI: 4 elements OR Status of 3 Chronic Conditions include: 1 or more chronic illnesses with severe exacerbation/progression/side PFSH: 3 of 3 ROS: 8+ systems effect of treatment Exam: 8+ systems Subsequent Visits- SNF/NF - Requires Face to Face Visit 99307 Requires 1 Problem Point and 1 Data Point (SF MDM) Examples include: 1 self-limited problem, 1 established stable problem on monthly HPI: 1-3 elements ROS/History: not required Exam: Problem focused - 1 system 99308 Requires 2 Problem Points AND 2 Data Points (L MDM)Examples include: 2 or more self-limited minor problems, an acute uncomplicated injury or illness and a related chronic condition HPI: 1-3 elements History: Not required ROS: Pertinent (1 system ) Exam: 2-4 systems 99309 Requires 3 Problem Points AND 3 Data Points (M MDM) Examples HPI: 4 elements include: 1 or more chronic illnesses with exacerbation, 2 or more chronic ROS: 2-9 systems illnesses with status included in HPI, undiagnosed new problem with uncertain Exam: 5-7 systems prognosis (i.e. lump in breast), Acute illness with systemic symptoms, Acute uncomplicated injury PFSH: 1 of 3 99310 Requires 4 Problem Points AND 4 Data Points (H MDM)Examples HPI: 4 elements include: 1 or more chronic illnesses with severe exacerbation/progression/side ROS: 10 systems effect of treatment, Acute or chronic illness or injuries that may pose a threat Exam: 8+ systems to life or bodily function (i.e. multiple trauma, MI, Acute Renal Failure, Respiratory distress/failure, or psych illness with potential threat to self or others) PFSH: 3 of 3 Time based billing expectation: 10 minutes. *MUST Include the statement: Greater than 50% of time spent face to face in counseling and coordination of Time based billing expectation: 15 minutes. *MUST Include the statement: Greater than 50% of time spent face to face in counseling and coordination of Time based billing expectation: 25 minutes. *MUST Include the statement: Greater than 50% of time spent face to face in counseling and coordination of care Time based billing expectation: 35 minutes. *MUST Include the statement: Greater than 50% of time spent face to face in counseling and coordination of care Procedure Codes 69210 - Ear irrigation with curette 10060 - Incision and Drainage, abscess simple 51705 - Suprapubic Catheter Change 43762 - PEG tube change Time-Based Billing - Requires Face to Face Visit AND Documentation of Time in Plan 99315 Patient discharging from facility within 24 hours or pronouncement of death/release of body Requires a face to face evaluation; HPI should include a brief overview of any complications or events during stay, along with treatments or changes to treatment regimen OR if Discharge from life should include provider declared patient deceased and is closing chart. 99316 Patient discharging from facility within 24 hours or pronouncement of death/release of body 99497 Advanced Care Planning No specific requirements; HPI should include a brief overview of any complications or events during stay, along with treatments or changes to treatment regimen Documentation must include: Brief account of discussion, explanation of advanced directives, who was present, and time spent face to face Minimal time amount to bill is 15 minutes 99356 Prolonged Services MUST be billed in addition to visit code of 9930799310 and include BOTH of the following: 1.Time spent must be beyond usual expectation for service code (i.e 99308 15 minutes+30 minutes=45 minutes total time) 2.Documentation in plan must reflect time spent, overview of discussion, who was present Time based billing: 30 minutes or less *Note: If the visit is a discharge from life and the patient did not declare the patient deceased, then the note is not billable and should be dropped as a short note in the EMR Time based billing: greater than 30 minutes Time based billing expectation: After 15 minutes up to first 30 minutes ; 99498 for each subsequent 30 minutes documented Time based billing expectation: Expected service code time PLUS an additional 30 minutes Code Decision Making Progressive Care Medical Group - Coding Worksheet HPI, History and ROS, PE Initial H&P Visits - Assisted Living - Requres Face to Face Visit 99324 Requires 1 Problem Point and 1 Data Point (SF MDM) - Examples include: 1 self-limited problem, 1 established stable problem HPI: 1-3 elements ROS/History: not required Exam: Problem focused - 1 system 99325 Requires 2 Problem Points AND 2 Data Points (L MDM)- Examples include: 2 or more self-limited minor problems, an acute uncomplicated injury or illness and a related chronic condition HPI: 1-3 elements ROS/History: 1 system Exam: 2-4 systems 99326 Requires 3 Problem Points AND 3 Data Points (M MDM) - Examples include: 1 or more chronic illnesses HPI: 4 elements with exacerbation, 2 or more chronic illnesses with status included in HPI, undiagnosed new problem with ROS: 2-9 systems uncertain prognosis (i.e. lump in breast), Acute illness with systemic symptoms, Acute uncomplicated injury PFSH: 1 of 3 Exam: 5-7 systems 99327 Requires 3 Problem Points AND 3 Data Points (M MDM) - Examples include: 1 or more chronic illnesses HPI: 4 elements with exacerbation, 2 or more chronic illnesses with status included in HPI, undiagnosed new problem with ROS: 2-9 systems uncertain prognosis (i.e. lump in breast), Acute illness with systemic symptoms, Acute uncomplicated injury PFSH: 1 of 3 Exam: 5-7 systems 99328 Requires 4 Problem Points AND 4 Data Points (H MDM)- Examples include: 1 or more chronic illnesses with HPI: 4 elements severe exacerbation/progression/side effect of treatment, Acute or chronic illness or injuries that may pose ROS: 10 systems a threat to life or bodily function (i.e. multiple trauma, MI, Acute Renal Failure, Respiratory distress/failure, or psych illness with potential threat to self or others) PFSH: 2 of 3 Exam: 8+ systems Subsequent Visits- Assisted Living - Requires Face to Face Visit 99334 Requires 1 Problem Point and 1 Data Point (SF MDM) - Examples include: 1 self-limited problem, 1 established stable problem 99335 Requires 2 Problem Points AND 2 Data Points (L MDM)- Examples include: 2 or more self-limited minor problems, an acute uncomplicated injury or illness and a related chronic condition 99336 99337 HPI: 1-3 elements ROS/History: not required Exam: Problem focused - 1 system HPI: 1-3 elements ROS/History: Pertinent (1 system ) Exam: Expanded Problem focused - 2-4 systems Requires 3 Problem Points AND 3 Data Points (M MDM) - Examples include: 1 or more chronic illnesses HPI: 4 elements PFSH: 1 of 3 with exacerbation, 2 or more chronic illnesses with status included in HPI, undiagnosed new problem with ROS: 2-9 systems uncertain prognosis (i.e. lump in breast), Acute illness with systemic symptoms, Acute uncomplicated injury Exam: 5-7 systems Requires 4 Problem Points AND 4 Data Points (H MDM)- Examples include: 1 or more chronic illnesses with HPI: 4 elements severe exacerbation/progression/side effect of treatment, Acute or chronic illness or injuries that may pose ROS: 10 systems a threat to life or bodily function (i.e. multiple trauma, MI, Acute Renal Failure, Respiratory distress/failure, Exam: 8+ systems or psych illness with potential threat to self or others) PFSH: 2 of 3
