Wiki ROV Guidelines

stpat

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For an ROV visit, 2 out of 3 key components are required. My question is, doesn't Medicare guidelines require that one of the two has to be Medical Decision Making? For instance, if you have a Detailed History, a Detailed Exam and low complexity Medical Decision Making, then you would have to choose 99213 instead of 99214 if Medical Decision Making has to be one of the two.
 
CPT Guidelines

I believe Medicare follows the same guidelines as those in the CPT book. 2 of the 3 must be met; however, medical necessity must also be a contributing factor. Does the nature of the presenting problem, what it takes for the phyisican to work it up, and course of treatment constitue a higher or lower level of medical necessity. A good question for the doctor to ask himself would be "What would my peers do?" in the same case situation (must compare apples to apples!)

For example as work up/tx of a possible UTI in a healthy 35yo woman who has had UTIs in the past is most likely a bit less complicated than that of a 78yo shut-in with confusion and not other presenting symptoms.
 
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