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Thread: High Level Visits

  1. #1

    Default High Level Visits

    AAPC: Back to School
    I am having some trouble with some of my docs E/M documentation on high level (4 or 5)
    visits. I know the PE should be comprehensive with review of 8 organ systems. But I was also taught that the code is driven by MDM more than the PE. My docs always do 6-7 organ systems but the MDM is high. So can't I still bill a level 4 or 5 for them? Thanks for any input on this you can give me!

    Dawn CPC, CCC

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    For an established patient you must meet 2 out of the three key components. If you do not have a high enough PE then no you cannot let one component drive the encounter. I think what you may have heard is that for estb patient MDM drives more than history so if you history were comprehensive and MDM moderate with a comprhensive exam then you should defer to the level 4 for the MDM.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Two of three key components for established visit

    You need to meet or exceed the requirements for two o the three key elements to determine the level of service.

    If you have a HIGH MDM and a Comprehensive History OR Comprehensive Exam you can code 99215.

    If you have a MODERATE MDM and a Detailed History OR Detailed Exam you can code 99214.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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