Tips for Reimbursement

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1. Primary Diagnosis:  Professionals may be reimbursed for their time assessing Oral Hydration (dry mouth) employing the FishburneTabs®OH via Medicare or Medical Insurers for patients diagnosed with diseases or conditions such as:

  •   Diabetes

  •   Cardiovascular disease

  •   Immune disorders and Transplant

  •   Cancer (in treatment)

  •   Autoimmune Disease (Lupus, Sjögrens, RA, Scleroderma etc.)

2. Embed one of the following appropriate ICD 10/11 codes under the Primary Diagnosis:

  • K11.0 – Atrophy of salivary gland

  • K11.1 – Hypertrophy of salivary gland

  • K11.7 – Disturbances of salivary secretion

  • K11.8 – Other diseases of salivary glands

  • K11.9 – Disease of salivary gland, unspecified

  • R58.2 – Dry mouth, unspecified

  • M3501 – Sjögrens Syndrome with dry eye

  • M350C – Sjögrens Syndrome with dental involvement

  • M3500 – Sjögrens Syndrome, unspecified

3) Use Evaluation and Management codes to process for clinician time, first determine:

New Patient Evaluation and Management Codes

Code

Description

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically a ppropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the dale of the encounter.

99202

Office or other outpalient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total lime is spent on lthe date of the encounter.

99203

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the dale of the encounter.

99204

Office or other outpalienl visit for lhe evaluation and managemenl of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of IotaI time is spent on the date of the encounter.

99205

Existing Patient Evaluation and Management Codes

Code

Description

Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional

99211

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straighforward medical decision making. When using time for code selection, 10-19 minutes of IotaI time is spent on the date of the encounter.

99212

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the dale of lhe encounter.

99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the dale of the encounter.

99214

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the dale of the encounter.

99215