2 of 3 for established office vist E/M coding

geminitc81

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Traverse city/ Detroit
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does it matter which 2 0f the 3 established office vists 99214-99215 are document?

The reason why i ask is becus I went on a web site EM UNVERSITY which has been very helpful, and for a 99214 example they gave on a free 1 hour course it says to be ethical becuz a 99214 is the second most used codes in office vists, we should use the MDM as one of the 2 of 3 desion making.

could someone tell me if this is correct?
 

pamtienter

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NAB Member
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Mound, MN
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Definitely take the MDM into consideration. Technically, you need 2 of the 3 components, however, if the history and exam are meeting 99214 or 99215 and your MDM is lower, it's a good sign to look at the medical necessity of those 2 other components. A lot of time I wouldn't code the level 4 or 5 because the complete ROS or comprehensive exam wasn't necessary for the chief complaint.
 

Allison L. Wickham

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The MDM is the most important key component because it supports the medical necessity of the encounter. If a physician choose to doucment more history or exam he can he just should not bill for it. All services hinge on Medical Necessity which is supported by MDM. As always there are expections because of the "Grey areas" of medical coding and auditing.
 
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