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Thread: E & M Question

  1. #1

    Red face E & M Question

    AAPC: Back to School
    I read an article in the AAPC Coding Edge (June 2007) where it was stated that "treatment of any patient requiring prescription drug should support the billing of at least the level three code 99213." It goes on to say, when an established patient is prescribed medication the service should be no lower than a 99213. My question is, does this also hold true for new patients? If a new patient is prescribed medication should the code be a least a moderate level of risk for the medical decision making portion of the E & M code?
    Last edited by mlillard; 02-07-2008 at 01:37 PM.

  2. #2
    Join Date
    Apr 2007


    Very possible. If new patient comes in with 2 or more stable chronic conditions, a mild exacerbation of a chronic condition or a new problem and the doctor prescribes a new prescription, a level 3 is pretty easy to justify. If the patient comes in with chronic conditions and the doctor just refills meds that the patient has been taking for a while, this would not justify a level 3 new patient.

  3. #3
    Join Date
    Apr 2007
    Watertown, NY


    For an Established patient the MDM portion on 1 self limited to minor problem this is NOT true it comes out to straight forward decision making.but if multiple problems or chronics are addressed the outcome is different, depends on what the pt is being seen for.
    for an established patient you must meet 2 of the 3 elements to bill for a 99213, either
    History= 1+HPI, 1+ROS, 0 PH,FH,SH
    Exam= 6+ bullets (97 guidelines) or 2+body areas or organ systems(95 guidelines)
    MDM= low complexity
    MDM the ordering/adding/refilling is not always enough.
    for a new patient you have to meet 3 of 3 Elements. History, Exam AND MDM, if something is not meet it goes to a lower service.
    Hisory= 1+ HPI, 1+ ROS 0 PH, SH, FH
    EXAM= as above
    MDM= straight forward.
    there are several audit tools to determin the level of MDM
    the example above i self limted to minot problem would meet the MDM portion but they have to do the rest.
    hope this helps

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