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E&M Level of Care

  1. #1
    Default E&M Level of Care
    Medical Coding Books
    We have a new patient with a "Detailed History", "Expanded Problem Focused", and "High Medical Decision Making".
    Would you code it as the lowest level (EPF) of 99202?
    Per AAPC CPC Study Guide, two of three key components are needed to make established patient level visit. I am unable to find information for 1995 or 1997 guidlines showing how to code NP & Established patient when there are three different key components.

  2. #2
    Location
    Columbia, MO
    Posts
    12,910
    Default
    For new patient you must meet or exceed all three key components. So in other words the lowest of your three components will determine the level even though the other two exceed the requirement for that level. So yes in your example you would got to the 99202.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Biloxi, MS
    Posts
    6
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    Yes, your example depicts a 99202 level of service based on the EPF exam.
    Kimberly L. Crear, CPC, CEMC

  4. Default Agreed
    I agree, But I would question whether this is a documentation issue. High MDM and Detailed History don't always fit with an EPF PE. If you are concerned provider isn't documenting all PE elements that were done, you might want to review with provider.

    Jim S.

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