Coding Corner Answer

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Patient A: 99213-25, 96401, J9250 x 3

Coding Rationale:

The visit is an established level-three visit due to the following:

• The patient history is expanded problem-focused; the history needs three out of three elements of the history of present illness (HPI), review of systems (ROS), and past family and social history (PFSH). Since the ROS is a problem-pertinent review of system, the level of the visit cannot be above expanded problem-focused.
• The exam is expanded problem-focused.
• The medical decision making is of low complexity.

The methotrexate injection should be coded with CPT 96401 because this drug is considered to fall under the “certain monoclonal antibody agents and other biologic response modifiers” description for this code. See this month’s coding article entitled, “A Rheumatologist’s Dilemma—96372 vs. 96401”

Patient B: 99213-25, 96372, J1600

Coding Rationale:

The visit is an established level-three visit for the following reasons:

• The patient history was expanded problem-focused because the HPI was brief. The history needs three out of three elements of the HPI, ROS, and PFSH. Since the HPI is brief, the level cannot be above an expanded problem-focused level.
• The exam is expanded problem-focused.
• The medical decision making is of low complexity.

The myocrisin injection is coded with CPT 96372 because this drug falls under the “therapeutic, prophylactic, and diagnostic injection” description for this code.