99213 vs 99214

wmpowers

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Having problems deciding which level is correct, provider saw patient for sinusitis and gave two injections, scoresheet states level 99214 but it's a problem focus visit for one diagnosis, is it right to use 99214?
 

Chelle-Lynn

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Medical necessity vs the E&M scoring or point system is often a sticking point for coders. While we want to use the scoring process we also need to balance the final E&M level with medical necessity. For example:

  • An patient comes in for follow up on a resolving ear infection with no on-going problems or issues.
  • Physician completes a detailed history
  • Physician completes a detailed exam
  • Physician completes a minimal MDM

While the 2 of 3 rule applies for an established patient; we need to consider if the history and exam detail was medically necessary to determine the final assessment of the patient. It comes down to a case by case situation. While we are not physicians we need to apply common sense to some of this situations.

To answer your question above we would need to see the full documentation as it often comes down to how the physician documented the records.
 
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