Ok, i'm confused because i'm studying for cedc exam and trying to come up with the History level and these are the options: Level 1 is Prob. foc. Level 2 is EPF Level 3 is also EPF. Whats the difference between Level 2 and Level 3? Thanks
You might find this page helpful:
http://www.fpnotebook.com/Manage/Billing/EmEmrgncySrvcs.htm
CPT Code 99282
Key Components (All 3 meet or exceed requirements)
1. E/M Expanded Problem Focused History
2. E/M Expanded Problem Focused Exam
3. E/M Low Complexity Medical Decision
(Problem Severity)
1. E/M Low Severity Problem
2. E/M Moderate Severity Problem
CPT Code 99283
Key Components (All 3 meet or exceed requirements)
1. E/M Expanded Problem Focused History
2. E/M Expanded Problem Focused Exam
3. E/M Moderate Complexity Medical Decision
(E/M Moderate Severity Problem)
As everybody else has mentioned, the difference between these boils down to MDM and Medical necessity (MDM and Med. Nec. are related, but not the same thing)
Medical Necessity is based on the Nature of Presenting Problem (NoPP, for short, since I don't want to type it out...)
Minimal/minor/self-limited = Something that will probably go away on its own (eg, cold, bug bite) - minor problems don't have much risk, and deciding what the Dx and Tx plan doesn't take much thought, so these problems usually correspond with SF MDM.
Low = Acute uncomplicated illness or injury (allergic rhinitis, simple sprain, etc.) - Problems are more severe than 'minor', but still don't pose much risk. They may require more testing to rule out something more serious (eg, pneumonia, or a broken bone), and/or treatment by PT, IV fluids (only), OTC drugs, or minor procedures with no risk (sutures, simple closures).
Moderate = The prognosis is uncertain, or has the potential to be bad enough to require eventually turn into a high severity problem. Acute complicated injuries are also in this category (head injury with loss of consciousness, colitis, pneumonia) - these problems may require more invasive or complex diagnostic procedures, and the treatment also carries its own risk (usually prescription drugs, or IV fluids with additives are involved, but other relevant examples for ED are minor surgeries with risk factors (minor outpatient surgeries, closed Tx of fracture or dislocation, w/o manipulation).
High Severity - they've practically got one foot in the grave, and need immediate treatment to save their life and/or bodily functions, OR the diagnostic or therapeutic procedures required for their problem are dangerous on their own (major surgery, diagnostic endoscopy/cardiovascular imaging studies with identified risks)
So if you're not sure if you should choose low or moderate, ask yourself these questions:
How bad is the problem (Does it require immediate care)?
What would likely happen if they didn't get treatment at that moment (or soon)?
What did the doctor have to do to find the diagnosis?
What is he doing to treat it? - Are there potential side effects/risks of either the Dx or Tx procedures?
Does the patient have any other problems that could complicate their presenting problem, its diagnostic procedures, or its treatment (eg, diabetics have more risk for infection w/open wounds)?
You can usually get an idea of how severe the problem is in the HPI and in the plan - (since that's kind of the point of HPI) - the plan is the most telling, though. If the doctor just said, "get some rest and fluids and FU w/PCP in a week if not better), it's probably low. If he prescribed something, scheduled a referral or urgent follow-up, gave a shot (antibiotic, tetanus, anti-emetic), or just seemed concerned in general, it's probably moderate.
Check the clinical examples in Appendix C of the CPT to get an idea of what kinds of cases are considered Level I, II, III, etc...
Hope that helps!