If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
No, that is incorrect. For established visit levels, 2 of the 3 must meet the LOS. So if you have Detailed History, EPF Exam, High-Complex. MDM, Overall visit is level 4...99214, because at least 2 of the elements meet the requirements for a level 4 visit--History and MDM.
I agree with Meagan, with the cautionary statement that most places now will consider MDM to be the one that would draw it down.
I code 2 of 3 to meet the level of service, but for me its
history and mdm must meet
or
exam and mdm must meet
Be sure to check your payor rules before automatically assuming MDM is one of the two criteria that must be met for a level on established patients. Medical NECESSITY, not DECISION MAKING, is considered the "overarching criteria" for deciding the level, per the 1995 and 1997 Documentation Guidelines from CMS. These are not the same. It is perfectly acceptable and proper to assign 99214 for an encounter with detailed history and exam, but low MDM. The documentation must show the medical necessity for the extra work involved in the detailed history and exam (why would it be done for a simple diagnosis such as pharagitis, for example) but to say that MDM must be one of the two key elements is incorrect unless the payor rules specifically state this.
For established you need only 2/3, so you can drop the lowest. In the case of a new person you'd need 3/3. That's what the guidelines say so that's what we code too.