Name: Socrates DOB: 469 BCE Date of Service: 11.27.12
Start time: 2:30pm Stop Time: 3:15pm. Total Face Time: 45 minutes
CPT: 90836, E/M ?????
CC: F/U for "Self Knowledge"
Interval History: Patient's checking behavior has not worsened. He met with one of his students yesterday, about whom he has had some homosexual fantasies, and had a dream last night in which he was trapped in a cave where he could only see shadows.
ROS: none
PFSH: The patient works closely with his students.
PME:
- Speech-Greek
- Thought processes-logical
- Thought Content: Focussed on dream
- Affect: Mildly Anxious
- General Appearance: Wearing toga
- Other: Uses intellectualization and reaction formation as defenses
Dx: Anxiety NOS, consider OCD
Current Meds: none
Labs: Ordered-none; reviewed-none
Allergies: Hemlock
Psychotherapy Note: Interpreted dream in the context of the patient's concerns regarding his homoerotic fantasies.
Plan:
Continue psychoanalysis 4x/week
And here we go again with the coding:
The interval history has, maybe 1 or 2 elements, say associated symptoms (checking), and timing (an implicit "overnight"). In any case, it certainly doesn't have 4 elements, so it's a brief history.
There is no ROS.
And there is one element in PFSH.
So for the level of history,
Level of Hx
|
HPI
|
ROS
|
PFSH
|
Problem Focussed
|
Brief
|
None
|
None
|
Extended Problem Focussed
|
Brief
|
1 System
|
None
|
Detailed
|
Extended
|
2 Systems
|
1
|
we end up with "problem focussed".
Once again, the Exam has 6 elements.
And for the MDM:
You get 1 problem point for checking, an established, stable problem.
There are 0 data points.
And the risk is low, for one stable, chronic illness.
Making the MDM straightforward.
In summary, then:
Level of Care
|
Hx
|
Exam
|
MDM
|
99212
|
Problem Focussed
|
1-5
|
Straightforward
|
99213
|
Extended Problem Focussed
|
>6
|
Low Complexity
|
99214
|
Detailed
|
12 from 2 or more organ systems
|
Moderate Complexity
|
99215
|
Comprehensive
|
2 from each of 9 organ systems
|
High Complexity
|
This gives us a 99212 E&M code.
Now, this was interesting as an exercise, but I don't really want to do this kind of careful review for every note I write. It would be easier to keep the note to a minimum and bill as a 99212, which most notes will probably turn out to be, anyway. But then, sometimes, it's possible to eke out a 99213, or even a 99214, and this makes a very real financial difference.
So is it worth it to comb through every note? I don't know. Thoughts?
