It is not always possible to support higher E/M levels even if it "adds up"; it's based on the nature of the problems. The ability alone to generate a level of history and exam equal to a 99214 is not the basis for billing the code. So, for some patients, a 99214 might be appropriate; but a 99214 is not universally/categorically the level of service to be billed when a patient with 3 stable problems is evaluated.
Are the problems actual disease processes/comorbidities; underlying problems with manifestations; consider and document when problems managed by other physicians affect your MDM.
It doesn't matter that the 3 chronic problems, e.g., HTN, hyperlipidemia, DMII were stable. It doesn't matter that there were no changes in management of the problems, or new interventions. The overall level of MDM is considered Moderate when managing these 3 chronic conditions; and that's even without Rx mgmt.
I found many physicians fall short in developing a History to include a more meaningful chronicle of a problem since onset or last visit - especially with chronic problems.
I've attached advice that I give to my physicians; all 98 of them/11 specialties (examples of the problems in the attachment are primary care-type)
p.s. I can't tell if it's attached or not. : /
Holler if it's not or if it is and found it helpful.
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