AmandaW
Guru
Since you only need 2 out of 3 for a subsequent progress hospital note, must you have an interval history at all? Or exam at all? Would chief complaint, exam, and MDM documentation be sufficient?
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Wiki two out of three?
- Thread starter AmandaW
- Start date
MikeEnos
Guest
Yes, you could pretty much drop the lowest score. If no history is documented at all, but you have an expanded problem focused history (2 organ systems, so vitals and cardiovascular for example) and moderate medical decision making you have enough for a 99232.
By contrast, you could have no exam at all, but just an expanded problem focused interval history and moderate medical decision making. Same thing, 99232
By contrast, you could have no exam at all, but just an expanded problem focused interval history and moderate medical decision making. Same thing, 99232
AmandaW
Guru
Thanks so much. Hopefully that's a general rule (CPT) and doesn't alter with your location. I haven't really found anything about it with my MAC-Novitas Solutions.