Choosing E/M level

timiket

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What is the correct way to choose the E/M level service. Example: If you have a Problem focused History, Comprehensive Exam and Comprehensive Medical Decision Making for a New patient visit. Would you choose the lowest level 99201 since it's a problem focused history or 99203 taking it down one level since you have meet 3/3 for a new patient and I only have 2/3. Is there a guideline published regarding choosing the level of service where I can see a black and white answer. Please help:confused:

Timea Toth, CPC, CIC
Urology Practice
 

dmaec

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yes, it would be taken down to the 99201 - the guideline "is" you need 3 of 3 for New Patient or Consult.

{that's my opinion on the posted matter}
 

ARCPC9491

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What is the correct way to choose the E/M level service. Example: If you have a Problem focused History, Comprehensive Exam and Comprehensive Medical Decision Making for a New patient visit. Would you choose the lowest level 99201 since it's a problem focused history or 99203 taking it down one level since you have meet 3/3 for a new patient and I only have 2/3. Is there a guideline published regarding choosing the level of service where I can see a black and white answer. Please help:confused:

Timea Toth, CPC, CIC
Urology Practice

Unfortunately you would have to use 99201 - it's in any CPT book - E/M University is also a wonderful resource.

It seems to me that if you have a comprehensive exam and high medical decision making, you should have more than a problem focused history. The documentation for a PFH is so minimal that virtually every problem could qualify for this.

Is this due to lack of provider documentation? (i.e. no PFSH, no ROS, etc.) If so, I would educate your provider on how to obtain a proper history from a compliance standpoint. Show him/her that you have to code 99201 - when it really should be a higher level and why....more importantly tell them about the reimbursement differences, that'll get them listening. ;)
 

tennislaurie

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Generally, providers have new pt's fill out a questionnaire/form that serves as a review of systems that the physician then reviews with patient, etc. so perhaps this was not done or not found in the chart. At any rate, for those visits needing 3/3 components to assign an E/M code, just remember that you can only charge as high as the lowest level.
 

dmaec

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dwmt1 - for new or consult - you'd need 3 of 3 components (History/Exam/MDM)
You can have only 2 PFSH and still have a "new" patient or consultation -
The level of est/new or consultation is determined by three main components, again - the level of HISTORY, level of EXAM and level of MDM.
 
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Depends on the level

Okay but for New Patients and Consultations, do you need all three PFSH to be documented?

That depends on what level of E/M you're trying to meet.
Level 1 or 2 new patients or consults - No PFSH is needed

Level 3 new patient or consult - you need at least one item in any one of the PFSH areas (so if you have a past med hx you're okay)

Level 4 and 5 new patient or consult - you need all three PFSH (at least one item in each of them)

You might want to sign on to emuniversity.com to learn more about E/M services.

F Tessa Bartels, CPC, CPC-E/M
 
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