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Wiki High Level Visits

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dphillips

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I am having some trouble with some of my docs E/M documentation on high level (4 or 5)
visits. I know the PE should be comprehensive with review of 8 organ systems. But I was also taught that the code is driven by MDM more than the PE. My docs always do 6-7 organ systems but the MDM is high. So can't I still bill a level 4 or 5 for them? Thanks for any input on this you can give me!

Dawn CPC, CCC
 
For an established patient you must meet 2 out of the three key components. If you do not have a high enough PE then no you cannot let one component drive the encounter. I think what you may have heard is that for estb patient MDM drives more than history so if you history were comprehensive and MDM moderate with a comprhensive exam then you should defer to the level 4 for the MDM.
 
Two of three key components for established visit

You need to meet or exceed the requirements for two o the three key elements to determine the level of service.

If you have a HIGH MDM and a Comprehensive History OR Comprehensive Exam you can code 99215.

If you have a MODERATE MDM and a Detailed History OR Detailed Exam you can code 99214.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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