Wiki CPT 99214

[Ruthannpardo]

If my provider has a patient with an acute uncomplicated illness or injury, orders a unique test (ex; strep test in office) reviews the results of that test and writes a prescription, does this qualify my provider for a moderate 99214? And, can the same be said for my provider when he sees a child with an ear infection for example, provides a in office test, reviews the results of that test and prescribes ear drops?

 

[csperoni]

Check out the full AMA 2021 outpatient guidelines. For outpatient after 2021, you code on MDM or time. MDM is determined by 2 of 3 elements from problem, data and risk.
Problem: Acute uncomplicated illness or injury = low level (level 3)
Data: 1 test = minimal or none (level 2)
Risk: rx management = moderate (level 4)
Unless time is documented and supports a higher level, this is clearly level 3. No grey area.

 

[OpenClaims]

I agree with the above that unless there is clear documentation of time supporting a level 4, then this encounter would be a level 3 based on MDM.

If my provider has a patient with an acute uncomplicated illness or injury, orders a unique test (ex; strep test in office) reviews the results of that test and writes a prescription, does this qualify my provider for a moderate 99214? And, can the same be said for my provider when he sees a child with an ear infection for example, provides a in office test, reviews the results of that test and prescribes ear drops?

 

[Ruthannpardo]

Thank you both.