Practical Tips Regarding Exam Codes

This a major red flag and not worth the extra couple of dollars.  At the minimum, don’t bill level 4 or 5 exam codes to State Farm or Geico.  This is a very common lawsuit against doctors so trust me when I say to stay away from 99204/99214 and 99205/99215 codes.

2.  Make sure your examination findings are different.

I represented a medical doctor where every patient had a level 8 pain on their neck and low back and every patient had the same exact range of motion.  This is impossible.  I’ve represented another medical doctor who said every patient had insomnia which is statistically impossible. 

3. Make sure you don’t prescribe every patient who was in an accident the same “3x week for four weeks.” 

You will call me crazy but I am telling you this is a pre-determined treatment plan.  Every patient cannot require the same “3x week for four weeks.”  A patient with a low level pain might require two visits per week.  A patient with sever pain may require five visits per week.  

Go to google and search for “Croft Whiplash Treatment Guidelines.”  You will see that if you follow Dr. Croft’s guidelines for cervical injuries that every patient will get a slightly modified treatment plan depending on the severity.  You can adopt Dr. Croft’s guidelines as a justification for making treatment plans for your patients.

4. Make sure you examination includes:

(a) Patient history;

(b) Symptomatology and/or wellness care;

(c) Examination finding(s), including X-rays when medically or clinically indicated;

(d) Diagnosis;

(e) Prognosis;

(f) Assessment(s);

(g) Treatment plan; and,

(h) Treatment(s) provided.

5. Make sure you list the pain scale for each body part!  A general pain scale does nothing to track a patient’s improvement. Saying someone has a pain at an 8 over their whole body is not as good as saying “neck 6/low back 10/right shoulder 5.”  This would be particularly helpful in a personal injury case.