Wiki What is the level of E&M service 99213 or 99214 ?

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Mah89

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What is the level of E&M service 99213 or 99214 ? consider the scenario " An established patient present for follow up of HTN, DM2 and CC of Sore throat; Documented appropriate Hx and PE; A/P: Htn and DM2 are stable, for Sore throat prescribed Azithromycin.
 
twizzle said:
What level do you think it is and what is your rationale? Try to come up with your answer and then others can pitch in with their thoughts - that is the only way to truly learn.
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Appreciate your quick reply. I would say 99214, MDM A and C meats the criteria for Moderate level. What is your take on the scenario?
 
Mah89 said:
Appreciate your quick reply. I would say 99214, MDM A and C meats the criteria for Moderate level. What is your take on the scenario?
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Generally speaking I would agree with you but it would need the whole documentation for the encounter to fully decide if 99214 is appropriate.

Were any tests performed to support that DM and HTN were stable (vital signs would obviously indicate what the BP was) but was an EKG done or were any labs performed to confirm DM was stable - A1c for example? In other words, is medical necessity supported?

If the answer is 'yes' then 2 stable chronic problems, acute uncomplicated illness, Rx drug management would theoretically support 99214.
 
Thanks! and just to debate, The overall MDM is moderate but if we look into the problems Vs, management only Rash is addressed with the Rx drug (Table-C Moderate) and Rash comes under Low therefore the overall MDM is LOW 99213?!
Please correct if im wrong>The problems addressed Vs and management options should be interlinked...
 
Mah89 said:
Thanks! and just to debate, The overall MDM is moderate but if we look into the problems Vs, management only Rash is addressed with the Rx drug (Table-C Moderate) and Rash comes under Low therefore the overall MDM is LOW 99213?!
Please correct if im wrong>The problems addressed Vs and management options should be interlinked...
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I would likely consider this 99214 as well, for problems and risk with the limited information provided. Not sure what you're referencing here about rash???? Original post stated 2 chronic stable problems addressed (DM & HTN) = moderate problem. Prescription management = moderate risk

If what you are asking is whether the level you get from problems has to be the same problems that you are leveling for risk, the answer to that is no. I would also imagine if the provider is actually addressing the DM & HTN, there is likely prescription management for that as well. But it does all depend on the documentation. It can't be a situation where the patient is going to the provider due to the sore throat and the provider just mentions - HTN stable. They have to address/treat the problem. Just like listing the patient's medications doesn't count as prescription management.
The AMA guidelines are the best reference.
 
csperoni said:
I would likely consider this 99214 as well, for problems and risk with the limited information provided. Not sure what you're referencing here about rash???? Original post stated 2 chronic stable problems addressed (DM & HTN) = moderate problem. Prescription management = moderate risk

If what you are asking is whether the level you get from problems has to be the same problems that you are leveling for risk, the answer to that is no. I would also imagine if the provider is actually addressing the DM & HTN, there is likely prescription management for that as well. But it does all depend on the documentation. It can't be a situation where the patient is going to the provider due to the sore throat and the provider just mentions - HTN stable. They have to address/treat the problem. Just like listing the patient's medications doesn't count as prescription management.
The AMA guidelines are the best reference.
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Perfect! Thanks for your time. "If what you are asking is whether the level you get from problems has to be the same problems that you are leveling for risk, the answer to that is no. from this point " a female Pt present for chest pain and Sore throat, upon assessment concluded as "Lump in Brest" - ordered Mammogram and for sore throat Rx given"--- This is still 99214 ?

Finally the above scenario <Correction to Sore Throat>. "DM is stable upon review previously ordered labs and HTN is under control with the current regime, for the both condition A/P is "Continue Current Meds"- This fall under "Rx drug management" ????
If you ask me "Continue Current Meds" will not fall under the criteria.

Exclude typos.
 
An order to continue current medication, after evaluating the problem definitely meets "Prescription drug management." I'm assuming the note also indicated the actual meds and dosing elsewhere. Otherwise, I would not count it.
From NGS Medicare:
  1. Please define prescription drug management relative to MDM.
Answer: In order to count prescription drug management there must be:
  1. A prescription drug that the practitioner is evaluating the appropriateness of using for the patient; and/or continuing to prescribe for the patient.
  2. Documentation on the prescription drug(s) that are being considered and the reason why they are being considered.
  3. Documentation of a practitioner’s decision to discontinue a prescription drug or to adjust the current dosage relative to changes in a patient’s condition.
  4. The patient condition, possible adverse effects, potential benefits, etc. of the patient using this prescription drug.
Prescription drug management is based on the documented evidence that the provider has evaluated medications during the E/M service as it relates to the patient’s current condition. Simply listing medications that patient takes is not prescription drug management. Credit will be provided for prescription drug management as long as the documentation clearly shows decision-making took place in regard to those medications.
 
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