• 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 the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Does 99214 = 99204 or 99205?

Create Wiki
K

kgarnette

New
Messages
2
Location
Wilmington, NC
Best answers
0
I had always been taught that a level 99214 visit would be the equivalent of a 99204 for a new patient. However, another coder is telling me that 99214 would actually equal 99205 for a new patient. Can anyone help clarify and direct me to documentation to support the finding? Thanks!
 
You can't just cross over an established pt to a NP visit. You need to take the history, exam and MDM into account. See below:

A 99214 that had a Det, Det, Mod would be a 99203
A 99214 that had a PF, Det, Mod would be a 99201
A 99214 that had a Comp, Det, Mod would be a 99203
A 99214 that had a Comp, Comp, Mod would be a 99204
A 99214 that had a Det, Det, High would be a 99203

I can't even think of a scenario where the components of a 99214 could ever equal a 99205. Anyone want to try to come up with one (and remember the MDM can't exceed the level).

-Jen
 
You can't just cross over an established pt to a NP visit. You need to take the history, exam and MDM into account. See below:

A 99214 that had a Det, Det, Mod would be a 99203
A 99214 that had a PF, Det, Mod would be a 99201
A 99214 that had a Comp, Det, Mod would be a 99203
A 99214 that had a Comp, Comp, Mod would be a 99204
A 99214 that had a Det, Det, High would be a 99203

I can't even think of a scenario where the components of a 99214 could ever equal a 99205. Anyone want to try to come up with one (and remember the MDM can't exceed the level).

-Jen
 
Either you didn't understand them, or they don't know what they are talking about. Jen spelled out all the possibilities above, but there is no scenario where a 99214 (which is a detailed history and exam, with moderate MDM complexity) would cross-walk to a 99205 (which is a comprehensive history and exam, with high complexity MDM.) Even based on time, a 99214 is typically 25 minutes, a 99205 is 60. Not even close.

In fact, I wouldn't even recommend your original anecdote. 99214 does not equal 99204. The complexity is the same (Moderate) but a 99214 requires a detailed history/exam whereas a 99204 requires a Comprehensive history/exam.
 
Last edited:
You must log in or register to reply here.
Top