Does anyone know where I might find documentation on how to select the level of an office visit when there are 3 different levels of components? For example I have a visit with Expanded Problem Focused History, Comprehensive Exam & Moderate Complexity Medical Decision Making
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Wiki Selecting an E/M level with 3 levels of components
- Thread starter bringl
- Start date
MikeEnos
Guest
This information is right in the Evaluation and Management section of CPT, and there is more info in the guidelines.
To answer the question, it depends on if the patient is new or established:
-A new office patient requires 3/3 key components to be met or exceeded, so therefore in your example the 'weakest link' is the expanded problem focused history which limits you to a level 2 new patient office visit, 99202
-An established office patient requires 2/3 key components to be met or exceeded, so therefore in your example you can drop the lowest score, you meet the requirements for a level 4 established office patient visit, 99214 (comprehensive exam, moderate medical decision making.)
To answer the question, it depends on if the patient is new or established:
-A new office patient requires 3/3 key components to be met or exceeded, so therefore in your example the 'weakest link' is the expanded problem focused history which limits you to a level 2 new patient office visit, 99202
-An established office patient requires 2/3 key components to be met or exceeded, so therefore in your example you can drop the lowest score, you meet the requirements for a level 4 established office patient visit, 99214 (comprehensive exam, moderate medical decision making.)
MnTwins29
True Blue
E/M guidelines
From the CPT book, in the E/M guidelines, it states that if 3 of 3 are required, then all three key components must meet or exceed the stated requirements. If 2 of 3 are required, then two of them must meet or exceed requirements. So, in your example, you would choose the level for the EPF if 3 of 3 are required or the detailed/moderate level if 2 of 3 are required.
Does that make sense?
From the CPT book, in the E/M guidelines, it states that if 3 of 3 are required, then all three key components must meet or exceed the stated requirements. If 2 of 3 are required, then two of them must meet or exceed requirements. So, in your example, you would choose the level for the EPF if 3 of 3 are required or the detailed/moderate level if 2 of 3 are required.
Does that make sense?
thank you
Mike & MnTwins29,
Thank you to you both. I think you have helped me wrap my mind around this to where I can now help my physicians understand how I am coding their visits. I was actually looking for somewhere in the CPT E&M Guidelines where it stated "drop the weakest link" or drop the lowest. Must be met or exceeded should work
Mike & MnTwins29,
Thank you to you both. I think you have helped me wrap my mind around this to where I can now help my physicians understand how I am coding their visits. I was actually looking for somewhere in the CPT E&M Guidelines where it stated "drop the weakest link" or drop the lowest. Must be met or exceeded should work
cmsexton
New
I work with physicians on E/M documentation. A website that you can use to help teach them is emuniversity.com it is great and was developed by a doctor as well. Tons of information on many different scenarios.
jmcpolin
True Blue
Go to www.Code-USA.com
They have an E & M coding sheet on their tools page that let's you know exactly how many items you need from each category to make it level 3,4,5. It has helped me tremendously. You can print it right off of their site.
They have an E & M coding sheet on their tools page that let's you know exactly how many items you need from each category to make it level 3,4,5. It has helped me tremendously. You can print it right off of their site.