• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

To what extent does MDM contribute to level of visit?

Z

zora2002

Guest
Messages
2
Location
queen creek, AZ
Office visit for an established patient; EPF history, EPF exam, MC decision making. Am I able to code 99214 due to MDM is highest? My understanding is that 99213 is to be coded due to 2 out of 3 (one of those being MDM) do not constitute 99214. I recieved feedback recently that 99214 is applicable due to MDM trumps other two categpories. Can I please get some feedback on this? Thanks!
 
As often happens, maybe you are thinking of medical "necessity" instead of medical "decision making" trumping over the history and exam. You are correct with 99213 when following E/M coding guidelines. The documentation guidelines will say that medical NECESSITY will be the overarching criteria used to determine the correct code. Just having a moderate level of MDM will not necessarily mean 99214 can be assigned. Yes, the History and/or exam should meet that standard but the medical necessity needs to be met as well.
 
You must log in or register to reply here.
Top