Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, November 28, 2012

A Simplified 99213

Okay. I've plowed through figuring out how to E/M code three different notes. And in case you were wondering, I can't remember what to do from one note to the next. I have to keep referring back to my own posts. I imagine after I've done it 100 or so times, I will remember. But the whole process is so meaningless, so devoid of context and content, that I can't retain it.

(I've decided there should be a new way of swearing at people: "Oh yeh!? Well E/M code you!")

I can't do this for every single note I write. I NEED a shortcut.

So here it is:

With few exceptions, all my notes will be either a 99212 or a 99213. On the rare occasion when I think I've spent a lot of time on complicated issues, especially psychopharm, I'll code formally and see if it's worth a 99214.

How to differentiate 99212 from 99213?

Well, since you only need two out of the three key components to meet any level, I'm going to ignore the most convoluted one, MDM, and just focus on History and Exam.

And I absolutely refuse to include another E/M@!3#&%#  Table.

Exam is the easiest. You need at least 6 elements for a 99213.  So my note template should look like this:

General Appearance:
Thought Process:
Thought Content:

Even in the most Freudian session, I should be able to come up with 6 of these.

Exam? Check!

Now History. You may recall, or not, that a 99212 History is Problem Focussed, and a 99213 History is Extended Problem Focussed.

So what's the difference between a Problem Focussed History and an Extended Problem Focussed History?

1 ROS!

That's it!

Both require a brief HPI, including 1-3 elements,  and no PFSH. So just 1 ROS.

Now I'm really disgusted.

And now that I've uber-simplified things, these are some questions I have:

1. Does insight count as its own exam element?
2. Does writing, "ROS negative for anxiety or depressed mood," constitute a valid ROS?
3. What am I missing?
4. Can I list defenses as "Other" on the exam?
5. Do dreams count as one element of the history?

And once again, to summarize:

99213=6 exam elements and 1 ROS.

Now I need a template I can use. Maybe next post.


  1. Does time need to be documented?

    1. I'm not sure if it NEEDS to be documented. The template designed by Seth Stein, attorney for the NYPSA, includes start time, stop time, and total face time. I suppose it couldn't hurt.
      The question of whether time needs to be indicated separately for the portion of the session spent on E/M has come up. My understanding is that the E/M time is subsumed under the total time, but really, it's confusing.

    2. Well my first post did not publish. I am certified coder and this will help you with coding a 99213
      HPI: patient having lucid dreams every two three evenings, and trouble falling a sleep and or staying a sleep, nothing changed in appepetite, living or social life to cause a change.
      Duration (every two-three evenings) Content (lucid dreams), Quality (falling sleep)
      ROS 1( consititutional)
      Change in presecription and offer counseling sessions
      OR Spent greater than 50% of 15 minute counseling patient and coordination of care with PCP. This will also support a 99213 Hope this helps !