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Thread: EM Question Please Explain

  1. #1
    Join Date
    Apr 2007

    Default EM Question Please Explain

    AAPC: Back to School
    I am having problems with EM questions where I am provided with the info and need to decide what code to select. [If somebody can please help me understand this I would be grateful. [/B] This is the question along with the answer and why it is this answer. I do not get it.


    Jenny returned to Dr. Hinder five years after her last visit. She rendered herself for eczema that had progressed. Dr. Hinder performed a comprehensive exam and a detailed history. The documentation for the encounter indicated multiple management options a moderate amount of data to be reviewed and a high risk of complications. What level should you report?
    a. 99202
    b. 99203
    c. 99204
    d. 99205
    The correct answer is B

    This is the rational that was provided to me by the computer and I am extremely confused. Rationale new pt has not been seen in three years who presents for a office visit. The DR meets or exceeds three of these requirements to bill for this level. This level requires a detailed history a detailed exam and low complexity medical decesion making.

    According to the scenario it says multiple management options which would which would be multiple. A moderate amount of data to be review which would be moderate. And a high risk of complication which would equal HC.
    I thought you needed to come up with 2 out of three criteria for MDM. How does Multiple, Moderate, High risk would you come up with Low Complexity Decesion Making.

    Maybe I am looking at this all wrong but if somebody can explain this to be in simple terms I would be grateful. I realize their must be a easy way to go about this but I am having major difficulties.

    Eddie Sottong

  2. #2
    Join Date
    Apr 2007
    Harrisonville, MO


    For a new patient you must have 3 of the 3 requirements, and not having seen the physician in over 3 years would make it a new patient, because the "multiple" and "moderate" doesn't mean conclusively that it is comprehensive then I would have also chosen the 99203. I hope that's somewhat helpful.

  3. #3
    Join Date
    Apr 2007
    Duluth, Minnesota


    Eddie, I agree - given the information that the MDM would be "moderate" - however when you take into account ALL THREE components of the E/M
    for new patient (or consult) you have to have 3 of the 3 elements - since they have a:
    Detailed HISTORY
    Comprehensive EXAM
    Moderate MDM
    you end up with a NEW PATIENT level 3 (99203) because the COMPREHENSIVE EXAM & MODERATE MDM elements gets dropped down to the next level (they only have a DETAILED History component).. so straight across it ends up to equals DET/History - DET/Exam - LOW/MDM (3 of 3 components).(even though you do have a higher EXAM/MDM)

    clear is mud?... hope this helps...
    Donna, CPC, CPC-H

  4. #4
    Join Date
    Apr 2007
    North Carolina



    Maybe this link will help. If you click on each blue link, it goes into further explanation.


  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default Detailed History

    The simple answer to your question is that because you only have a DETAILED HISTORY, the highest level you can choose is 99203.

    It's not that your MDM was at a low level, it's that the detailed history pulled all the work down to a level 3 because for a new patient you must meet or exceed all three levels.

    Just remember for a new patient (or Hospital Admit, or Consultation) the lowest element will dictate the level of service you can code.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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