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Tuesday, November 27, 2012

E/M Psychoanalysis Note-Tuesday

Here's the second note of the week:


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?