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Please Help!!!! Very Confused

  1. #1
    Location
    East Stroudsburg
    Posts
    43
    Default Please Help!!!! Very Confused
    Medical Coding Books
    Hi, I could really use some help with this.

    If I have an EPF history, a comprehensive exam and a moderate MDM for an established patient wouldn't I choose a 99213? Since I don't have 2 out of 3 components wouldn't I choose the one farthest to the left or would I choose the 2nd from the left?

    Please help ASAP, I am really confused about this. I always thought it was the one farthest to the left.

    Thank you,
    Christine

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    If it is an established patient then you may eliminate the lowest component and use the other two components for the level, in this case the history is the lowest so it may be dropped from consideration. You are left with comprehensive exam, and moderate MDM so the lowest of these two will determine the visit level. Moderate MDM equates to a 99214 without exceeding your level of comprehensive exam. I have never heard the method of "farthest from the left" so I have no idea what you are referring to with that.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Everett, WA
    Posts
    886
    Default
    I'm not sure what you mean by "farthest from the left". And I think your confusion may originate from thinking that two out of the three must be identical, i.e. being both "moderate" or "comprehensive?" This is not the case. Do as Debra advised and you can cross out one of the three components---in this case the expanded HPI. Now you have comprehensive exam and moderate MDM which = 2/3. Look in your CPT book for the established patient requirements and you'll see that comprehensive and moderate "meet" the "detailed" requirements" for 99214 (Level 4) but the MDM is lacking to assign to 99215 (Level 5). Therefore, 99214.---Suzanne E. Byrum, CPC

  4. #4
    Location
    East Stroudsburg
    Posts
    43
    Default
    Thank you both very much. I did think that two out of three must be identical and if not it would be the lowest level. I didn't realized you could drop the lowest one. Again, thank you so much.

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