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Reply with quote  #1 
My daughter had a weekend visit to a care center for r/o strep throat. The center took her temp, weight, did a rapid strep and her throat was examined , lymph nodes neck palpated and she was auscultated. She was asked 5 or 6 questions-duration, fatigue level, sick contacts-5 minut visit. I just received a bill coding for a level III visit-coded as 99213. This seems upcoded to me...thoughts?
Reply with quote  #2 
If the problem is new then the level will be 99213 only

if you went just for follow up for  existing sore throat i.e established problem then it should be billed with 99212
Reply with quote  #3 
CC: sore throat
HPI: Sore throat started 2 days ago.  Has fever.  Pain is mild.  Exposed to friend with same. (location, duration, associated symptom, severity, context - 5 bullets)
Allergies: none
Exam:  Looks well, throat red (one, maybe two, bullet(s))
ROS: poor appetite, no cough (2 systems)
Dx: sore throat
Rx: amoxil

New problem with systemic symptoms and medicine prescribed

Strong case for 99214. 

Seems simple but it may not be.  What if it is a peritonsillar abscess?  What if it fails to be correctly diagnosed and treated and leads to Acute Rheumatic Fever and lifelong heart disease?  What if it is an early symptom of acute leukemia?  Thrush related to undiagnosed diabetes or HIV?  Cancer from smoking?

These and more are possibilities every time a patient tells a doctor they have a sore throat.  Still simple?

Reply with quote  #4 
99213 seems reasonable if she’d been seen by them before ... if it was a normal appointment.
If she was covered by private insurance, I’d argue the correct code is S9050 or S9053
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