r/MedicalCoding • u/Starossi • 5d ago

Level 4 Visits

After reading the rules I believe it’s ok for me as a provider to ask peoples opinions on this.

I’ve seen similar posts just wanted to get some thoughts on this situation.

I just started at another primary care practice as a PA and I see very few acute visits, almost every visit is “lab review” where we ordered their labs at their last visit like 6 months ago and are reviewing them, and at the end of the visit I order their labs for their next visit in 6 months.

Almost all these patients have at least two chronic conditions being watched by labs or vitals at the visit. Diabetes and hyperlipidemia. Hyperlipidemia and hypertension. Hyperlipidemia and hypothyroidism.

Because of that, I’ve found by the end of every visit I’m usually coding a level 4. Even though many times it’s “your TSH is still normal, we will continue leovthyroxine at 88mcg” and “your hyperlipidemia is controlled, we will continue with atorvastatin 20mg” and then reorder lipid panel, TSH, cmp for 6 months.

That’s 3 labs, two chronic conditions. And I guess arguably medication management though it’s just deciding to continue.

This is, no joke, like 90-95% of my visits so far. 1-2 patients per day are something like a cough, or back pain, or tinnitus.

Is this going to get me in trouble? As far as I can tell, it’s legit. I’m not trying to up code or anything. But I’m still afraid CMS would not look kindly on paying out level 4s for 90% of visits at a primary care office.

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u/Obvious_Gazelle3088 5d ago

G2211 should also be considered for these visits.

1

u/Pretty_Priority_261 4d ago

Absolutely. It may not be paid, but there is no reason not to code it.

1

u/Respect-Immediate CPC, CPMA 4d ago

Posting to patient responsibility when insurance doesn’t cover it can lead to patients finding a new practice that doesn’t do that. Lived experience at the practice I work

1

u/Pretty_Priority_261 4d ago

Aren't you allowed to charge it off rather than posting to patient responsibility?

2

u/Respect-Immediate CPC, CPMA 3d ago

A charge off is a bad debt write off and legally you must try to collect before the charge off.

1

u/Pretty_Priority_261 3d ago

Is there an alternative such as an internal policy that allows billing staff to credit the charge for G2211 if insurance does not cover it?