Results 1 to 5 of 5

Medical Necessity

  1. #1
    Default Medical Necessity
    Medical Coding Books
    I have a physician documenting a detailed history and exam, but the MDM is of low complexity. The patient has a lumbar sprain and the physician is continuing the same meds and having patient return in one month.

    Would you give this a level four for an established patient or a level three?

    The HPI was brief, but with an extended ros and 1 history area, that's where the detailed history came from. I am just leary of coding as a level four as I don't see the medical necessity for a detailed exam when the patient essentially came in for a medication refill.
    Melony Reed CPC

  2. Default
    It sounds to me like a level 3. If the HPI is brief and the MDM is low, the exam could be comprehensive, and I would still say it is a level 3.

  3. #3
    Thanks!! That is what I was leaning towards myself.
    Melony Reed CPC

  4. #4
    Evansville Indiana
    Default level
    Please someone correct me if I am wrong, but if the HPI is brief, the highest level you can get for history would be a EPF, since you have to have 3 of 3 on history to qualify.

  5. #5
    cheermom68, you are correct. History is 3 of 3, so a brief HPI limits you to no higher than and EPF history level.

    Laura, CPC, CEMC

Similar Threads

  1. Medical Necessity
    By sparkles1077 in forum E/M
    Replies: 2
    Last Post: 02-10-2014, 09:09 AM
  2. Medical Necessity - counting key components
    By tovygoldstein in forum E/M
    Replies: 10
    Last Post: 08-15-2013, 01:35 PM
  3. Medical Necessity
    By hkatie in forum Dermatology
    Replies: 2
    Last Post: 01-20-2012, 10:21 PM
  4. Medical Necessity
    By lkerrison in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 05-21-2010, 06:41 AM
  5. Medical Necessity - coder with the severity
    By marleee in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-28-2008, 04:52 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.