here are my thoughts....is the doctor writing a one time prescription (antibiotic for an ear infection) or adjusting doses of htn and dm meds? If this is the factor that will determine if this visit is a level 3 or 4, I consider the problem and risk of the condition the meds will be treating. Should a infected cat scratch be a level 4, like a patient with bilateral pneumonia or uncontrolled hypertension. If this is your 4th ear infection this year, do you think because it is a "new" problem and the doctor gave you some augmentin, that that should automatically be a level 4? I try to explain it to the docs that way. I have one who has an e/m checklist in his brain...."oooh, new problem, and I wrote a script...I need 4 HPI, 2-3 ROS and 1-2 points of history,add a quick exam with vitals and presto...99214"drives me nuts!
Anyway, this is such a gray area! Check out the examples in the back of the CPT book of what is a 99213 vs a 99214.
In my head, 99215...pt is acutely ill...resp distress...siezure...so 99214, next step down...ear infection? not so much in my book...there may be risk...but....
Look at the examples on the table of risk for Moderate(99214)- pyelonephritis, head injury with brief LOC.
Unfortunately, there really is no right or wrong here...but I suggest you guys compromise and then be consistent and make a policy.
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