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May 9, 2019 14:00:46 GMT -5
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Post by stevil on May 9, 2019 14:00:46 GMT -5
Yes and no. Right now, the current guidelines call for statins and Ace inhibitors/ARBs for all patients on insulin. So any insulin dependent diabetic is a baked in level 4 billing code (out of 5). So whether the patient is well-controlled or not... Depending on how badly controlled they are, they may qualify for a level 5 code, but it's much harder to justify level 5s than 4s...
In other words, it's not uncommon to get paid the same for a super complicated patient as one who is well-controlled. But you do far more work for the one that's not controlled and carry more risk as a physician for the same pay.
Sort of. It all depends on how well they document the encounter. As long as they document that they addressed the issue in some way (which is not hard to do), they can justify billing for it. Reason being is it can impact medical decision making. More complicated patients require a more thoughtful approach. It doesn't have to take more time, it's just that they're more complicated so the thought is that you do spend more time reviewing labs and vitals before coming to a conclusion. I should also specify that this is for adult onset type 2s only though. You don't start kids on statins or blood pressure meds.
www.aafp.org/fpm/2003/1000/fpm20031000p31-uf2.gif
As I said above, look at the HPI section (stands for history of present illness). Since an ACE/ARB (blood pressure meds that protect the kidneys) and statins (coronary artery/stroke) are indicated for all adult onset type 2 diabetes, (since it's a metabolic syndrome with high risk comorbidities) you can also bill for hypercholesterolemia and hypertension because you're treating to prevent stroke, coronary artery disease, stenosis of arteries, etc. Thus it automatically qualifies as a level 4 or higher, depending on severity. If a patient is extremely high risk, you have to document well why/how that is and why you either needed to spend more time with them or reviewing their chart to bump then up to level 5.
I think I answered your question?