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99212 or 99213

  1. Default 99212 or 99213
    Medical Coding Books
    HPI -1-3, - Expanded problem focused; (if 4+- Detailed)
    ROS 1 - Expanded Problem focused
    PFSH- pertinent 1 - Detailed
    So the choice goes to the lowest history level
    History Level …………………………….Expanded Problem focused.

    PE- Constitutional 1 + BA 1 = 2… Expanded problem focused Examination

    MDM- Limited data reviewed and low risk to the patient of complications or death , if untreated- this fits in for this patient evaluation for MDM- that places the MDM complexity level- LOW

    2 out of 3 KC is enough to code . But her all 3 Key Components are met with.

    Hence it fits very well into the CODE 99213

    No way, it can be taken to/reduced to the lower level code of 99212

  2. #12
    Default
    Quote Originally Posted by cfullum View Post
    I too get a 99213. You only need 2 of the three components so you don't even need the MDM, you can get it from your HPI and exam.
    That may be true strictly from a CPT perspective, but if the MDM doesn't justify the higher level, then the whole thing could be denied as not medically necessary. MDM should always be the overriding indicator when choosing an E&M code.
    Walker Bachman, CPC, CPPM

  3. #13
    Location
    Kansas City, MO
    Posts
    431
    Default
    Quote Originally Posted by Walker22 View Post
    That may be true strictly from a CPT perspective, but if the MDM doesn't justify the higher level, then the whole thing could be denied as not medically necessary. MDM should always be the overriding indicator when choosing an E&M code.
    True...but in this case there is a MDM of LOW=99213. I agree with the doctor.

    Linda, CPC, CEMC

  4. Default
    always base your coding off MDM

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