Wiki E/M: 99202 or 203?

[gbgentry@earthlink.net]

New to E/M coding & I want to make sure I'm heading in right direction.
I have a comprehensive history, expanded problem-focused exam, &
low MDM. I'm thinking that it would be 202 since it's the lowest and
all three don't line-up but I'm not certain.

I have another where it's PF, Comp, & High MDM that I'm thinking is 99201
for the same reason.

Thanks.

 

[cgaston]

New patient codes must meet 3 of 3 levels, so you will have to use the lowest level.

 

[Pathos]

Hello,

The CMS E/M guidelines is a good place to learn some of the E/M components. Certain MACs (depending on where your practice practices medicine) also have additional clarifying guidelines.

However, cgaston is correct; with New Patients/Consult outpatient office visits, all three E/M components must match the E/M level, otherwise you must bill the lowest level of that component.

So for the first example:

1) Because the Exam is EPF, the visit should be 99202 (if New vs. Established rules agree with a New Patient visit).

Second example:

1) Because the History is Problem Focused, the visit should be 99201 (check New vs. Established again).

Unless Time documentation can be used as an overriding factor, and "Greater than 50% of the time (time amount must be specific) was spent on [add brief summary of what was discussed]. This "50+%" time cannot be part of History and Exam taking, but exclusively consultation and coordination of patient care.


Hope this is helpful, otherwise ask again or send me a PM.


Happy Monday!

 

[gbgentry@earthlink.net]

Thanks!