assigning evaluation and management codes to the following

a mother bring in her 6 mo.s old male child for a routine wellness check. An examination reveals the child to be in good health and making adequate progress.

a 62 year old diabetic female presents for check-up and dressing change of wound on left foot. An exam reveals the wound is healing. The nurse applied new dressing and patient will return for a check-up in one week.

Established patient on Lithium presents for routine blood work to monitor therapeutic levels and kidney function. A nurse reviews the results and advises the patient that test is normal and no change in dosage is indicated.

A 30 year old patient complaining of flu like symptoms, characterized by unremitting cough, sinus pain, and thick nasal discharge. An examination reveals Bronchitis and sinus infection. The patient is prescribed a 5 day course of Zithromax.

assigning evaluation and management codes to the following

[a mother bring in her 6 mo.s old male child for a routine wellness check. An examination reveals the child to be in good health and making adequate progress.

a 62 year old diabetic female presents for check-up and dressing change of wound on left foot. An exam reveals the wound is healing. The nurse applied new dressing and patient will return for a check-up in one week.

Established patient on Lithium presents for routine blood work to monitor therapeutic levels and kidney function. A nurse reviews the results and advises the patient that test is normal and no change in dosage is indicated.

A 30 year old patient complaining of flu like symptoms, characterized by unremitting cough, sinus pain, and thick nasal discharge. An examination reveals Bronchitis and sinus infection. The patient is prescribed a 5 day course of Zithromax.]

I'll guess

with the details you give as representing the complete note:

99391, 99211 (I am not sure if the checkup means the doctor saw the patient), 36415, 99213

99211

If the patient presented to the office for a lab test and the tests were normal with no change in treatment or medication and the nurse just conveyed the normal results face-face, then code 99211 cannot be billed in addition to lab test itself. There must be an abnormal result requiring the nurse to communicate with physician and a change is made for 99211 to be billed, a cognitive service must be rendered and medically necessary. There also must be an incident-to service and the incident-to rules apply. (Medicare)

Nancy--

I gave the 99211 to the foot dressing change. The lab test one got the venipuncture code only, no E&M.

99211

I know. It was a statement only because recently on seminars I give, people are confused about when they can and cannot use 99211.