Wiki Options for Coding 99215

[mmcneil03@yahoo.com]

It has come to my attention that the review of 5 or more chronic illnesses will support the medical complexity to code 99215 (with appropriate history and exam, of course). Can anyone confirm/deny this information?

Thank you!

Megan

 

[mitchellde]

You need 2 out of the three components of MDM to be high complexity, so number of dx , plus either complexity of information or risk at the highest level will yield high complexity MDM

 

[OCD_coder]

To add-on to what Debra says, if the Hx and PE are comprehensive did it warrant such extensive work? Some carriers require that the MDM be one of the 2 components, so if the patient has at least 4 chronic/stable problems this is only 1 of 3 elements/component available to meet the MDM level required to support a 99215, the limiting factor will be one of those components such as data or risk.

Example:
Dx options: 4 pts (1 pt for each stable chronic problem)
Data: 0 pts
Risk: Moderate (2 or more stable chronic conditions)

High Risk Identifiers:
At least one of the conditions needs to be in an acute exacerbation status clearly documented or any other factor outlined at the High level on the Risk Table.

I often use this article by NAMAS to educate on medical necessity and documentation:
http://www.medtronsoftware.com/pdf/2013/070113_Educational_Series_E&M_Auditing.pdf