E/M coding-99214 vs 99215

mhink693

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We have a doctor that is trying to bill 99215 on patient visits where patient is being seen say for knee osteoarthritis. Hasn’t had PT, hasn’t had injections, but has been dealing with this for a while and is now having total knee. Doctor goes over risk. He is wanting to bill 99215 and personally I think it’s so hard for a doc to get to a 99215 in ortho with no time statement. Does anyone have any good examples of what is classified as a severe exacerbation or what is qualified as a major surgery. I feel like I get conflicting answers which makes it so hard to code.
Does anybody agree? I feel ortho is so black and white.
 
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