Wiki 99231-99233

[KaylaRieken]

So I was told by an auditor once that this was a good rule of thumb for most instances:

99231- stable doing well--no changes
99232- new problem, not responding adequately to therapy and additional work is needed
99233- major problem--high risk--but not critical

What is everyone's opinion on this? Should it matter on how many diagnoses the patient has?

 

[AmandaBriggs]

I typically use this as a rule of thumb as well to help support medical necessity and when educating providers. Very similar verbiage is also included in the description of these codes in CPT.

 

[csperoni]

I would say it's a good general overview, but coding should always be based on history, exam, MDM (or time if > 50% & appropriately documented).
You could certainly have a major problem--high risk, but neither the exam or history meet detailed for level 3. The number of diagnoses (and their complexity) fall into MDM number of diagnoses and risk. MDM is only 1 component.

 

[KaylaRieken]

I guess I am running into the issue of having more documentation that I feel I need for the HPI and Exam. I also always have several diagnoses but didn't feel I should always be giving 99232-99233. Does that make any sense?

 

[csperoni]

The overarching requirement is always medical necessity. That is why many believe MDM should always be used. Particularly with EMRs, it is very easy to overdocument a patient's entire unrelated, irrelevant history. That does not mean every clinician overdocuments, or does so with the intention of a higher code. You could have 1 diagnosis and level 3, or 4 diagnoses and level 1. You simply need to look at hx, exam & MDM for each note, with the overarching guideline of medical necessity. My employer does not require MDM to always be used, but I would say 99% of the time, it is.