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Wiki coding 99215

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LJones9199

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Is it necessary to include a high medical decision making a part of getting 99215 or can you use just comprehensive hx or comp exam? I'm hearing mixed messages.

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CMS Documentation rules say that the MDM should be the overarching criterion in determining the overall level of E/M service reported, so it carries the most weight in the code selection. It wouldn't be medically necessary to bill a 99215 for a trivial or insignificant problem, any more than it would be appropriate to bill an MRI for a tiny abrasion on someone's knee. Look into what it would take to bill a preventive exam if the doctor is documenting so many history and exam elements, in the absence of a presenting problem that matches the effort. The doctor may need to re-evaluate what/how much they're documenting and why.
 
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