tci Medicare Compliance & Reimbursement - 2014 Issue 9

Reader Question: Determine Sick Visit Vs. Camp Physical

Question: We had an asthmatic patient present because she required an Epi-pen to take to camp with her. We gave her a full camp exam and prescribed an Epi-pen for her peanut allergy, as well as Proventil to take with her. Should we report this as a problem-focused visit or as a camp visit? Our pediatrician initially billed 99211 with V15.01 (Personal history of allergy to peanuts) but the insurer rejected it. Answer: This visit could actually go either way. If you choose to report a problem-focused visit, you’ll probably report 99212 (or another code from the...

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