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Wiki Other opinions

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Campbell, TX
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Good Morning.
Could I get another set of eyes on this encounter. Provider coded as a 99205, everything through Athena and Codify says it is a 99204. If anyone else could look and give me input I would appreciate it.
 

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Whenever trying to determine an E&M level, you need to determine the level of each component of overall MDM: problem, data and risk. You must have at least 2 of those at a specific level to reach that overall level. Alternately, you may bill base on time. My 2 second review indicates this seems like a patient with several complicated problems, but likely only a level 5 if based on time. However, I do not see time documented, so that is not an option.
My 60 second review then comes up with:

PROBLEM: Moderate. Many chronic problems, some not even stable. However, I did not see severe exacerbation, progression or side effects for any of them, nor a problem that poses a threat to life or bodily function.

DATA: Moderate. 6 tests ordered. It's possible there were also review of other tests that may or may not have been ordered by another provider. However, regardless of the number of tests ordered/reviewed, in order to get extensive data, you must also have either independent interpretation or discussion with another HCP. I didn't see either.

RISK: At this point, irrelevant if problem & data are moderate. But for educational purposes, I also get moderate here for prescription drug management.
 
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