Wiki Determining E/M Level

[dyoungberg]

I'm confused and hope someone can help me understand.

Clinical documentation for a new in office patient supports comprehensive history, detailed exam, and moderate complexity medical decision making. Am I right in billing 99203 or should it be 99204? Guidelines say for new patients 3 of 3 components are required for a level of service. I don't have 3 of 3. So do I go with the lowest of the three?

 

[lcashburn]

The code for a new patient visit with the components you noted would be 99203. As you said, for a new patient visit you must have 3 out of the 3 components matching or exceeding the level you choose. If all three do not meet the criteria, then you drop down a level until all three match or exceed. So for your example patient, comprehensive history and a moderate MDM would qualify for 99204 but since the exam was detailed you drop down a level to 99203. Now all three meet (the exam) or exceed (the history and MDM) the level you select.