Clinic


AAFP Quiz - CME credits
Coding & Billing :
AAFP Start from bottom up

Preventative:
AHRQ EPSS Recommendations Tool
Preventative:
USPTF Guidelines

FM:
AAFP : FP Notebook
Urgent Care / Clinic:
Wiki-EM
Pediatrics :
U of BC Peds : CHOP Clinical Pathways : U of Chicago Quick Reference : U of Michigan Peds Resources (for pt) :
Rx Consult: GlobalRPH : table of mc rx | abx review ppt.
Occupational Health:
guidelines per state.
Reference:
Medscape Reference | Uptodate | Dynamed | Merck Manual Reference | MedBullets

Rx Information :
Iodine.com (for pt)

SoapNote.org : online tools - assist decision making and notation.
Choosing Wisely | Dubin EKG Reference Sheet.

Medical Calc : MDCalc : Fluids | Corrected Ca | Corrected Na
- Neuro:
GCS
- Pulm:
PERC | Wells PE | CURB65
- CV:
TIMI UA/NSTEMI | TIMI STEMI | Wells DVT | CHADSVASc
- GI:
MELD | RANSON | NAFLD Fibrosis Score | ANI Score (NAFLD vs Etoh)
- Addiction:
Opiate Risk / ORT |
- Misc:
Sepsis | CT Head/Trauma

OHSU Physician Consult & Referral Service
> OHSU General: 503-494-4567
> Doernbecher : 888-346-0644
> Fax referrals : 503-346-6854
> pcs@ohsu.edu
> ohsu.edu/provider

OHSU Pysch Consult Line: OPAL Adults & Kids
9 a.m. – 5 p.m. Monday through Friday, excluding major holidays
Already registered.

> Toll-Free: 1-855-966-7255
> Portland Metro: 503-346-1000

  • =====================
PE: 1(VS) + 6(CORE) + 9(COMP) system Vital Signs: P / BP / RR / SpO2 / T I have reviewed the VS. 

PE:  
Const: Well-nourished, Well-developed, No acute distress.*.  CV: +S1/S2, No murmurs, RRR *.  Resp: respiratory effort w/o labor*. CTAB*.   Psych: Awake, alert & oriented x3*. Appropriate mood and affect*.

  • Neuro: CNs II-XII grossly intact*. 
    Eyes: no conjunctival injection *. 
    ENMT: Atraumatic external nose and ears *. Moist MM *. 
    Neck: Symmetric, trachea midline* 
    GI: No hepatosplenomegaly *. Nondistended / Nontender*
    MSK: Normocephalic /Atraumatic *. 
    Skin: Warm, Dry*. 
  • =====================
PE (full)
General : alert & oriented, ø acute distress, well-nourished, well-dressed
Neuro : CN2-12 grossly intact, sensation intact & strength 5/5 all extremities. negative rombergs.
Psych: cooperative, affect appropriate, good judgement & reason, non-suicidal
Head: NCAT
Eyes: PERRL, EOMI. vision grossly intact.
ENT: trachea midline, neck supple, no cervical LAD
Cardio: RRR w/o murmurs, +S1, +S2, no heave.
Pulm: CTAB w/o WRR, good air movement, >6 word sentences.
Abdo: +bowel sounds, soft & non-distended, non-tender, no CVA tenderness, no HSM
MSK: NCAT, 5/5 strength all extremities, full ROM grossly, normal gait. no edema.
Skin: intact w/o lesions, warm & dry

  • =====================
ROS: no f/c, good PO regular diet w/o diarrhea/constipation nor abdominal pain, no CP or palpitations, no SOB / cough / wheezing.

  • ROS: 99213: hit ONE system related to current problem(s) ; 99214: hit TWO to NINE systems ; FULL =10 systems
  • Const: no F/C, no unintentional weight loss.
  • CV: no CP or palpitations
  • Resp: no SOB / cough / wheezing,
  • GI: PO regular diet w/o diarrhea/constipation nor abdominal pain,
  • Skin: no new rash or lesions.
  • =====================
  • FULL ROS: 14 point
  • 1. Constitutional (e.g., fever, weight loss)
  • 2. Eyes
  • 3. Ears, Nose, Mouth, Throat
  • 4. Cardiovascular
  • 5. Respiratory
  • 6. Gastrointestinal
  • 7. Genitourinary
  • 8. Musculoskeletal
  • 9. Integumentary (skin and/or breast)
  • 10. Neurological
  • 11. Psychiatric
  • 12. Endocrine
  • 13. Hematologic/Lymphatic
  • 14. Allergic/Immunologic
  • =====================
  • AP
  • -
  • -
  • - DDx:
  • > Plan:
  • > RTC:
  • > Precautions: RTC earlier/ ER if sx worsen.

Coding===================================

New Pt.
Comprehensive/Complex : 99205
Comprehensive/Moderate : 99204
Detailed: 99203
EPF: 99202
PF: 99201

New Pt - Preventative
Infant <1 yr : 99381
Early childhood 1-4 : 99382
Late childhood 5-11: 99383
Adolescent 12-17: 99384
Young adult 18-39: 99385
Middle Aged 40-64: 99386
Senior => 65: 99387

Est Pt. - General:
Comprehensive/complex : 99215
Detailed: 99214
EPF: 99213
PF: 99212
Minimal visit :99211

Est Pt - preventative
Infant <1 yo: 99391
Early childhood 1-4: 99392
Late childhood 5-11: 99393
Adolescent 12-17: 99394
Young Adult 18-39: 99395
Mid Adult 40-64: 99396
Senior =/>65: 99397
Post-procedure f/u: 99024

Medicare
welcome to medicare comp 162; G0402; has to be done within 12 mo pt getting onto medicare);
initial medicare wellness: G0438
subsequent medicare wellness: g0439


Special:
ASQ Developmental Screening : *** CPT code
Tobacco Cessation: - no code needed - document “tobacco use status recorded and discussed”
PHQ9: CPT code 96160 & document in onte “depression screening complete and f/u care discussed” - no dx needed.

Advanced care planning : 99497
Follow-up medicare adult wellness : G0439sub
New medicare wellness: G0438
IPPE: G0402
Pre-employment physical: v70.5, 99429,PE; “evaluation of subgroup”
Geriatric rounds; 99336
Home visit:
OB: 99213,OB - V22.0 or V22.1
Circumcision: 54150 (circ using clamp or other device w/ local black)
Nexplanon insertion: 11981
Knee injection: 20610
Toe nail removal:
Colposcopy:
57420
Impacted cerumen b/l removal: 69209
wart (cryotherapy): CPT 17110
OB US >14 wk:
76805;
pes anserine CS injection:
20610
post-op : 99024 (non billing code?)
Smoking Cessation : brief 3-10min is 99406 (or G0436 medicare); >10 min 99407 (or G0437 medicare)
Toenail trim: 11719

DM foot exams; initial g0245, subsequent g0246



Modifiers
24: unrelated e/m during global post-op.
25: separately identifiable e/m
53: procedure started but not completed due to risk to patient.
36415: blood draw fee

Geriatric Rounds Coding
New pt: 99324 (20 min); 99325 (30 min; low risk); 99326 (45 min; mod risk); 99327 (60 min; mod risk); 99328 (75 min; high risk)
Est pt: 99334 (15 min; min); 99335 (25 min; low); 99336 (40 min; mod); 99337 (60 min; high).

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