Results 1 to 3 of 3

Thread: 99214

  1. #1

    Default 99214

    Promo: Code Books
    What is the criteria for billing 99214 and getting paid according to Medicare guidelines

  2. #2
    Join Date
    Apr 2007
    Location
    Hartford, CT
    Posts
    718

    Default

    An established patient requires two out of three of the following components:
    1) Detailed history
    2) Detailed exam
    3) Moderate decision making

    Remember however that medical necessity is the main criteria for choosing any code, so if the medical necessity is not there it doesn't matter how much documentation you have, you can't bill a 99214.

    Doreen, CPC

  3. #3
    Join Date
    Apr 2007
    Location
    JC MO
    Posts
    110

    Default

    Quote Originally Posted by dclark7 View Post
    An established patient requires two out of three of the following components:
    1) Detailed history
    2) Detailed exam
    3) Moderate decision making

    Remember however that medical necessity is the main criteria for choosing any code, so if the medical necessity is not there it doesn't matter how much documentation you have, you can't bill a 99214.

    Doreen, CPC
    To determine the level only two of three are required …

    For example:
    A problem focused exam and detailed history and moderate medical decision making, equals a 99214. There is an exam but you do not have to consider that it was only a problem focused exam to determine that you can bill a 99214 based on medical decision making.

    In the same way, it is not appropriate to report 99214 with a detailed exam and history, and problem focused medical decision making because the detailed history and exam are not medically necessary (unless the history and exam were medically necessary to determine that the medical decision making was problem focused, which in the case of an established patient would be the exception rather than the rule).

    Another way that a 99214 can be reported is if the encounter is based on time and all of the required elements for billing based on time are documented.
    M.J.

Similar Threads

  1. 99214...really?
    By aprilsue in forum E/M
    Replies: 4
    Last Post: 07-16-2014, 09:46 AM
  2. 99214
    By cingram in forum E/M
    Replies: 10
    Last Post: 10-08-2013, 09:32 AM
  3. 99214
    By thelma in forum E/M
    Replies: 5
    Last Post: 10-25-2012, 09:16 AM
  4. Need help is this a 99214
    By dpumford in forum E/M
    Replies: 6
    Last Post: 04-25-2011, 01:01 PM
  5. ?? 99214
    By HBULLOCK in forum E/M
    Replies: 2
    Last Post: 09-10-2010, 09:17 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.