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Thread: coding 99215

  1. #1

    Default coding 99215

    AAPC: Back to School
    Is it necessary to include a high medical decision making a part of getting 99215 or can you use just comprehensive hx or comp exam? I'm hearing mixed messages.


  2. #2
    Join Date
    Apr 2007
    Lubbock, TX


    CMS Documentation rules say that the MDM should be the overarching criterion in determining the overall level of E/M service reported, so it carries the most weight in the code selection. It wouldn't be medically necessary to bill a 99215 for a trivial or insignificant problem, any more than it would be appropriate to bill an MRI for a tiny abrasion on someone's knee. Look into what it would take to bill a preventive exam if the doctor is documenting so many history and exam elements, in the absence of a presenting problem that matches the effort. The doctor may need to re-evaluate what/how much they're documenting and why.

  3. #3

    Default Thanks

    Thanks Brandi for your help. Will look into the other areas.

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