Wiki Billing E & M coding for Level 4 visits

[kathy a]

I am having a hard time understanding the 2021 E & M coding for level 4 office visits. My physician may see a patient who has 5 different issues that she is handling. That would at least qualify her for a Level 4.
The issue I am having is satisfying The Amount of Complexity and Data to be reviewed and Analyzed. She did do a # 92201-EO. So she ordered one test and she analyzed it, but we would only get to chose 1 correct.
For the Category 1 for Moderate she would have to satisfy 3 for Tests, Documents or Independent Historians. So she would not satisfy Category 1. She did not have any tests interpreted by other physicians-so did not satisfy Category 2.
Discussion of Management or test interpretation with external physician, other qualified health care professional. Sounds like she doesn't satisfy Category 3 either. She is not doing Med management or doing Surgery. This sounds like she will have to get down coded to a level 3. What is your take on this or could you please explain this a little bit better than what I am seeing ? Much different then the old guidelines. Thank-you

 

[Cheezum51]

In general, it's pretty difficult to meet the data category of MDM for a Level 4 exam. So you should be looking at the number and complexity of problems addressed at a specific visit and the Risk for those problems. Without knowing what the problems addressed were, I can't really advise as to whether or not they would meet the Moderate level. Can you be more specific as to the problems and how many are addressed at atypical visit?

Tom Cheezum, OD, CPC, COPC