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Please Help!!!
I am new to coding and I am having difficulty with the 99204 and 99205 codes.  I work for an Orthopedic wrist and hand surgeon/doctor.  In both 99204 and 99205 E/M codes you have to have a Comprehensive Exam.  I am having no problems getting to a comprehensive history or medical decision making of moderate or high complexity.  But I cant seem to get the exam anywhere near a comprehensive exam.  If what I'm doing is correct then it seems that the doctor would never be able to bill above a 99203.  I read the "Single Exam" guidelines on this website and it states that ALL bullets have to be met to bill a Comprehensive Exam, and I can't get to that point.  Please help. Am I doing something wrong? 

pjensen

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Reply with quote  #2 
Sorry for the delay.  That's a tough one.  If you are using the 97 guidelines, there is a musculoskeletal exam you can try, but probably will not work for you.  That leaves the 95 rules.  Here you need at least 8 organ systems.  It might take some thinking, but you can probably discuss 8 organ systems by using some general systems and then concentrating on those pertaining to the anatomic area being examined.  First, it would be fine to comment on the constitutional system by saying NAD.  Next it would be fine to say lungs are clear.  You could comment on the musculoskeletal system around the hand or wrist and also the neuro and cardiovascular systems in this area by checking pulses and sensation.  You could comment on lymphadenopathy which gives you the lympatic system and also on the skin which covers that system.  How many are we up to now?  I think that's seven.  Maybe it would also be reasonable and medically necessary by commenting on the psych system if the patient is going to be asked to take meds or engage in rehab.  There you go.  There are eight systems.  On the other hand, if the orthopod is considering surgery, it would be perfectly reasonable to do a general medical exam to assess if the patient is a good operative candidate.  In this case, you could just use the general multi-system exam in the 97 rules or simply comment on 8 organ systems using the 95 rules.  Again....sorry for the delay.

PJ
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