Wiki Confirmation of Pregnancy EM Level

[ELBrock]

Hello!
With the new Office Visit leveling guidelines being based on MDM or time alone, what level of EM would you consider the Confirmation Visit to be?
Prior to 2021 EM Leveling guidelines, we could use the history and exam to level the visit, but now that those are not calculated, using just MDM is a little tricky
If the provider documents time, that's easy-peasy. A 30 minute visit would be 99214. I have been encouraging my providers to document their time at these visits.
Without time, I am unsure if the "Number and Complexity of Problems Addressed" is a Low or Moderate level. Would confirmation of pregnancy be considered "1 acute, uncomplicated illness/injury," and so be considered Low, or would it be "1 acute illness with systemic symptoms" and so be Moderate?
The remaining two elements of determining MDM are more straightforward...I consider the Data Element to be Low/Moderate depending on if they order Prenatal Labs, outside Ultrasounds, STI screenings, etc, and if the patient has identified risk factors like Preexisting Diabetes or Hypertension that must be reviewed.

Thank you!

 

[nielynco]

Hello!
With the new Office Visit leveling guidelines being based on MDM or time alone, what level of EM would you consider the Confirmation Visit to be?
Prior to 2021 EM Leveling guidelines, we could use the history and exam to level the visit, but now that those are not calculated, using just MDM is a little tricky
If the provider documents time, that's easy-peasy. A 30 minute visit would be 99214. I have been encouraging my providers to document their time at these visits.
Without time, I am unsure if the "Number and Complexity of Problems Addressed" is a Low or Moderate level. Would confirmation of pregnancy be considered "1 acute, uncomplicated illness/injury," and so be considered Low, or would it be "1 acute illness with systemic symptoms" and so be Moderate?
The remaining two elements of determining MDM are more straightforward...I consider the Data Element to be Low/Moderate depending on if they order Prenatal Labs, outside Ultrasounds, STI screenings, etc, and if the patient has identified risk factors like Preexisting Diabetes or Hypertension that must be reviewed.

Thank you!

Usually, the pregnancy confirmation visit is a low level visit that involves only the confirmation and the patient may not even be seen by the physician. It is okay to order labs if you confirm pregnancy at this visit, but that should be the end of care as the other things you list are straying over the line to obstetric evaluation and care which would not otherwise be needed for this type of visit. I have to say that over the years, I have had many clients who, when audited, had to give back money on these "confirmation" visit for just this reason so tread carefully. As a presenting problem with no other pre-existing conditions that have to be evaluated (gyn complaints mainly or she is bleeding) and she is presenting because she either thinks she is pregnant due to home pregnancy test or thinks she may be pregnant because she has missed 2 periods the complexity will be low, not moderate. And a confirmation visit should not be taking 30 minutes unless there are other major issues addressed not relating to confirming the pregnancy. Under most circumstances, the confirmation visit would either be 99212 or 99213 at the most.