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E/M code 3/3 2/3 components

dyj

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just wanted to confirm: when all three components are required for coding the lowest key component decides the code

is it still hold true when two of three components are required to code? if not then what decidesE the code when all of three components are of different levels

thanks
 

mitchellde

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When a new patient or any other where all 3 key components are required then all three must be met or exceeded which then translates to the lowest component does determine the level of service as that is the one that is met and the others are exceeded.
On the 2 out of 3 as for established patients, I was always told to throw out the lowest and the next lowest is the one where the level will be met.
 

dyj

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thanks for the response

here MDM (medical decision making) does not decide the code?

i mean if for 3 components new patient office visit: detail history is given, expanded problem focused examination and high complexity decision, will code 99202 ?

and for the same example 2 components established 99214?
 

dclark7

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Check your insurance carrier policies, some are now requiring MDM to be one of the two key components used to determine the level. Anthem of CT has done this.
 

mitchellde

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MDM does not determine the level... what they mean when they say that is for established patient if you had comprehensive hx and detail exam with low decision making you should not go for a 99214 as the history was probably brought forward from a previous encounter therefor the MDM being the lowest component would bring the level to a 3. given the 2 scenarios yes the levels would be a 99214 or a 99202.
 
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