Home Forums Discussions Coding and Billing It?s different with doctors

The day to day stuff is the 214. You should get paid for the work done assessing three chronic, even though stable, problems. You've talked to the pt about them, reviewed the labs they had done, assessed their meds/treatments, probably discussed goals. This is utilizing your expertise and you should get paid for it. "Something really cool" should identifying the 215 and getting them controlled efficiently, not performing miracles.

Check out the FPM toolbox
www.aafp.org/online/en/home/publications/journals/fpm/fpmtoolbox.html

Under the Coding:CPT section, you'll find some PDF that go over examples of the variety of codes...
here's what one says about when to think about 914:
"Think level IV if you do any of the following at a patient visit:
? Order an X-ray and review it;
? Order an ECG and review it;
? See a new problem with uncertain prognosis (e.g., lump in breast);
? See a complicated injury (e.g., fall with loss of consciousness);
? See three chronic, stable illnesses;
? Spend more than 25 minutes with a patient."

and later there is an example of a visit:

"(Three chronic, stable illnesses)
CC: Follow-up on medical problems
HPI: 63-year-old male with hypertension. Blood pressure
has been controlled. Denies headache. His emphysema is
stable, but he does get mildly short of breath with activity.
His hypothyroidism is now stable. Recent thyroid stimulating
hormone testing was normal.
PH: Not smoking.
ROS: Noted above.
EXAM: Vitals: BP 138/78
Chest: Clear to auscultation
CV: Regular rhythm and rate
A/P:
Hypertension, stable, continue meds.
Emphysema, stable, continue meds.
Hypothyroidism, stable, continue meds."

Source: "Coding Level-IV Visits Without Fear" Thomas A. Waller, MD; Fam Pract Manag. 2006 Feb;13(2):34-38.
www.aafp.org/fpm/2006/0200/p34.html

I also, like AmazingDave, use the E/MUniversity to polish my documentation/coding.