Wiki HELP which E/M to code

[Jaslene08]

okay so I came across a report in which the levels are as follow:

Established patient (2/3 components)
however I have one of each:

History = Comprehensive
Examination = Detailed
MDM = Low

would this be coded is 99213 or a 99214??

Is there a rule of thumb for such outcomes??

THANKS!!!

 

[Machelle Freeman]

I was always told when you need 2/3, throw out the top (Comprehensive) and bottom (low). You are left with detailed. So, I would bill a 99214.

 

[Jaslene08]

thank you. So its the middle one. does this apply for any such case? Once I was told it went by a judgment call so I would chose the MDM level... Do you know of any links that explain these types of situations?

 

[Machelle Freeman]

I don't know where any links are for this rule, this is the way it was explained to me in school. But, this only works on when you need 2/3. If they are a new patient (9920_ or 9924_) you need 3/3, so you would throw out the top 2 and bill the lowest one. Hope that helps.

 

[amccracken1108]

thank you. So its the middle one. does this apply for any such case? Once I was told it went by a judgment call so I would chose the MDM level... Do you know of any links that explain these types of situations?

I have been researching alot of E/M stuff lately (I am also a CEMC), when the history and exam are so detailed and there is a low MDM, its best to consider the medical necessity of the encounter. I know we aren't doctors but is it necessary to exam a persons abdominal area because they have a splinter in their finger? You can also ask the provider as well to what their opinion is on the medical necessity of the counter.