Tip: Medical Necessity in E/M Coding
In E/M coding, medical necessity is evaluated using a five-level scale specifying the nature of the presenting problem as minimal, self-limited or minor, low, moderate, and high. These levels describe how each problem is related to illness, the severity of illness, morbidity and/or mortality, and prolonged functionality. They also indicate that the nature of the presenting problem is a contributing factor in determining an E/M service. Because each code level specifies part of the nature of the presenting problem for applicable services, this essential component should be included in the documentation requirements for many E/M codes.
Each month, “From the College” presents a coding scenario to test your knowledge. Tell us how you would answer the question by e-mailing the ACR coding/practice management list serve. To join, go to http://lists.rheumatology.org/read/all_forums and follow the instructions.
February coding scenario: A 45-year-old man comes in for his infliximab infusion but 40 minutes into the infusion, with only 200mg of infliximab, the patient develops a severe reaction. The physician discontinues the infusion and the flushes the line with normal saline. The patient is given an intravenous injection of methylprednisolone sodium succiante (40mg) and oxygen by nasal spray at two liters per minute. IV hydration of saline continues for forty minutes to flush out the infliximab. How should this be coded?
Look for the answer in March’s “From the College.”
January’s coding answer: 99212-25, 96413, 96415 x 1, J1745 x 58, 96401 J9250 x 3
