Wiki E/M leveling

[jenna.jepson@yahoo.com]

Can someone please help me clear this up? For a new patient, if the provider only addresses one condition in the HPI, can this only qualify as a 99202? (Time is not documented by the way).

I have an E/M tool from Optum and it says in order to qualify for a 99203, the provider needs to document 4+ elements OR status of 3+ chronic conditions. But when I am looking for other E/M leveling tools, I see some that say "3 chronic conditions OR 4+ elements". If the provider documents 4+ elements of only one condition, can that still qualify as a 99203? I hope this makes sense.

 

[thomas7331]

There is no requirement that there have to be multiple conditions in order to bill this level - the four or more elements required for an extended HPI can all be from the same chief complaint or problem. The status of 3 chronic conditions can replace the four elements in the event that the reason for the visit is to follow chronic conditions where the patient may not have a specific complaint or symptoms to document in terms of the usual HPI elements.

 

[kroemer4]

Status of 3 Chronic Conditions

Keep in mind that the status of 3 chronic conditions is best to be interpreted as 2-3 HPI elements per condition. It is not simply "Pt here for 6 mo f/u of HTN, DM, & COPD. No complaints, no new problems".

It is more "Pt is here for his 6 mo f/u of chronic conditions. HTN is stable on meds; pt has been exercising more and eating a low-sodium diet. Side effects addressed in the previous visit have ended. DM is controlled by lifestyle choices; pt's goal is to ensure no meds. A1c levels have been in the xx-xxx range, which is acceptable for this patient. COPD was recently exacerbated due to a viral illness. Pt saw Dr. X at the urgent care; I've reviewed the records and agree with the treatment plan. Pt has no other complaints and is tolerating medication well."