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Thread: 99213?

  1. #1
    Join Date
    Apr 2007

    Default 99213?

    AAPC: Back to School
    We have a patient who came in for an ocp check. The history and exam are exp prob focused but the mdm is straightforward. Since one of the factors needs to be mdm should this then be a 99212? They did refill her prescription for birth control but the presenting prob is 1 and amt data is 1. Thanks

  2. #2

    Default Hope this helps!

    I do believe that it would be 99213. You need to have 2 of the 3 components (history, exam, mdm) in order to code it this way. From what you have told me, you meet that criteria!

  3. #3


    I always bill by the MDM first then see if the HX and Exam meet, if the MDM only meets straightforward then I would only bill 99212.

  4. #4

    Default 99212

    I agree with the previous entry. I determine medical decision making and then code out the visit depending on the history and exam...


  5. #5
    Join Date
    Apr 2007
    Cape Girardeau, Missouri

    Default 99212-99213

    I agree with Loryanned. If you follow the CPT guidelines you must have AT LEAST two of the three key components that meet the criteria for that code. If you use 99212 you would only be meeting one of the three criteria.(ie straightforward DM). Therefore you would be guided away from that code to 99213 where you meet both expanded problem focused history and expanded problem focused examination.

  6. #6
    Join Date
    Apr 2007


    Thanks for the input. I always bill with the mdm as one of the elements because if you don't you will run into med necc issues. i actually thought it was stated somewhere that the mdm had to be one of the two you use when deciding level. anyway, thanks for your opinions.

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