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3 key elements of E&M

  1. Question 3 key elements of E&M
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    Are all 3 key elements of the E&M service required in order to be able to bill for an established patient, or could a physician skip one of them altogether and still be able to bill for an E&M?

  2. #2
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    Daytona Beach, FL
    Posts
    754
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    For an established patient only 2 of the 3 elements needs to meet the level billed. If you doctor neglects to document one of the areas, such as the history, you can still use the other 2 areas to get your level.
    Jodi Dibble, CPC

  3. Default
    JDibble is correct! In order to bill for an OV, you only need 2 of the 3 components. Sounds like you have all you need!

  4. #4
    Location
    North Carolina
    Posts
    3,126
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    Make sure medical necessity is maintained. If the provider renders a comprehensive exam and moderate to high MDM, reporting a 99214/99215 could present an issue. Lack of a history could make it difficult to support a high level. The history (for example) creates a picture of why the patient needs to be seen and the increased complexity of those presenting issues.
    Rebecca CPC, CPMA, CEMC




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  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Depends on the service provided
    The above are correct IF you are talking about an established patient office visit (99211-99215). But if you are talking about other service that may be provided to an established patient ... like hospital admission or consult ... it depends on the service provided.

    The rules are clearly spelled out the CPT guidelines for each procedure.

    F Tessa Bartels, CPC, CEMC

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