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Level 2 vs Level 3

  1. #1
    Default Level 2 vs Level 3
    Medical Coding Books
    Can anyone explain the difference between a level 2 and a level 3?

    I know it comes down to the decision making, but what I want is an example of a level 2 vs. a level 3.

    Thank you.

  2. #2
    Default
    Are you talking about admit codes 99222 and 99223?

    I always compare them to 4s and 5s for consults/new patients and the only difference is the MDM goes from moderate to high.

    It is hard to give an example because MDM is 2 of 3 so the exact same patient with the same problem could be moderate for one provider and high for another based on data points alone.

    You could have a patient being admitted for pnuemonia and they have HTN. By itself this is going to fall under moderate risk with 4+ dx points. The difference is in the data in this case.

    If the provider orders xrays, labs and an ekg that is 3 points, still moderate MDM.

    If the provider orders xrays, labs and does an ekg w/interp this is now 4 points and will put this up to high MDM.

    I don't know if this the type of example you are looking for but this is what comes to my mind first on a scenario that could go either way.

    Laura, CPC, CEMC

  3. #3
    Default
    Quote Originally Posted by katmryn78 View Post
    Are you talking about admit codes 99222 and 99223?

    I always compare them to 4s and 5s for consults/new patients and the only difference is the MDM goes from moderate to high.

    It is hard to give an example because MDM is 2 of 3 so the exact same patient with the same problem could be moderate for one provider and high for another based on data points alone.

    You could have a patient being admitted for pnuemonia and they have HTN. By itself this is going to fall under moderate risk with 4+ dx points. The difference is in the data in this case.

    If the provider orders xrays, labs and an ekg that is 3 points, still moderate MDM.

    If the provider orders xrays, labs and does an ekg w/interp this is now 4 points and will put this up to high MDM.

    I don't know if this the type of example you are looking for but this is what comes to my mind first on a scenario that could go either way.

    Laura, CPC, CEMC
    Thanks Laura -

    Yes, I am referring to inpatient (sorry, should have stated).

    My problem is I am trying to really figure out the differences in the levels. I work with hospitalists and lots of times they code level 3 when it doesn't meet the requirements. For example a person comes in with CC: shortness of breath. Their past history they have COPD, DM, and HTN. The dr does not documented his notes correctly, no labs are done or what have you. This is the problem I am having, I see it EVERYDAY, depending on the diagnosis. Or, they may have a data point for reviewing/ordering labs and thats it.

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