Wiki NP Visit when only 2 out of 3 components match

[linwoodleighjr@comcast.net]

NP visit with Expanded Problem Focused History, Comprehensive Exam, Low MDM. What CPT code would be correct? Or is documentation added? 99201-99205 need all 3 to match. This scenario only has 2 out of 3. Thanks

 

[mitchellde]

They do not need to match, you need all three documented. The lowest of the three components will determine the level. In your scenario with exp focused hx, comprehensive exam and low MDM for a New patient your lowest component is history so the visit level is 99202.

 

[mhstrauss]

NP visit with Expanded Problem Focused History, Comprehensive Exam, Low MDM. What CPT code would be correct? Or is documentation added? 99201-99205 need all 3 to match. This scenario only has 2 out of 3. Thanks

You have a History, Exam, and MDM listed...that's all 3 components. It is a 99202. I'm not sure what you think is missing...??

 

[CodingKing]

What's throwing you off is it's meets or exceeds. With new patient you code to the lowest of the three components

Since not all combination are accounted for in the code description, writing down the hierarchy for the 3 components can be helpful

Lowest to highest

History/Exam: Problem Focused -> Expanded Problem Focused -> Detailed-> Comprehensive

MDM: Straightforward -> Low -> Moderate -> High


Comprehensive exam meets or exceeds all possible E&M codes so you are good there.

Expanded Problem Focused History limits you to no higher than a 99202.

Low MDM is enough for 99202 or 99201. Since the other 2 components meet or exceed 99202 you can you use it.

 

[linwoodleighjr@comcast.net]

Thanks so much!!!

They do not need to match, you need all three documented. The lowest of the three components will determine the level. In your scenario with exp focused hx, comprehensive exam and low MDM for a New patient your lowest component is history so the visit level is 99202.