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Consults versus Office Visits

  1. #1
    Lightbulb Consults versus Office Visits
    Medical Coding Books
    Hello everyone!

    If a patient comes in to discuss test results and a plan of treatment for a condition(s), is it necessary for the physician to perform an examination to be performed in order to bill a visit code, example 99212-99215 for an established patient?

    Also, in the CPT book, most office visit codes for an established patient say 2 or 3 components must be met. For example, I have always thought, if an expanded problem focused history and medical decision making of low complexity and problem focused examination, a 99213 would be billed because the history and medical decision making match a 99213 and only 1 of the 3 components is outside of the 99213.
    I am now being advised in my organization, the 2 out of 3 components means as long as an expanded problem focused history and medical decision making of low complexity is performed with no examination done at all, then requirements have been met for a 99213. (this sounds weird to me)

    Can anyone advise me further on these issues.

    Thanks!

    Kim, CPC

  2. #2
    Default
    Hi Kim:

    If you take a look at your CPT book ( I use AMA's Professional Edition) on page#10 - 12 it gives you a description:

    I'll use 99213 as my example:

    99213 Office or other outpatient visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components:

    An expanded problem focuesd history;
    An expanded problem focused examination
    Medical decision making of low complexity


    Hope this helps.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Default
    So in your example, even if an examination is not done, as long as the history and medical decision making are performed, the provider can be a 99213?

  4. #4
    Default
    As long as the documentation supports a 99213 based on history and MDM.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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