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Picking level/elements of E/M

  1. Question Picking level/elements of E/M
    Medical Coding Books
    I can't seem to get a clear understanding of elements, bullets, and how to choose the correct level for an office visit.

    I have tried doing one of the self-audit forms, but still get confused.

    I understand completely on new patient, established patient, diagnosis, its just the level of exam I am having trouble with, such as 99213 vs 99214.

    Any suggestions??

    Thanks,

  2. #2
    Location
    Anaheim, CA
    Posts
    12
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    1995 exam guidelines: 99213 has the expanded problem focused exam which means 2-4 organ systems/body areas where as 99214 has a detailed exam where 5-7 organ systems/body areas need to be examined.

    1997 exam guidelines: for 99213 the document should have 6-11 bullets and for 99214 there should be at least 12 bullets documented.
    Basically if every element in the shaded area and at least one element in each unshaded area are not documented it goes down to level 4.

  3. #3
    Location
    Kansas City, MO
    Posts
    431
    Default
    Quote Originally Posted by alka View Post
    1995 exam guidelines: 99213 has the expanded problem focused exam which means 2-4 organ systems/body areas where as 99214 has a detailed exam where 5-7 organ systems/body areas need to be examined.

    1997 exam guidelines: for 99213 the document should have 6-11 bullets and for 99214 there should be at least 12 bullets documented.
    Basically if every element in the shaded area and at least one element in each unshaded area are not documented it goes down to level 4.
    the 1995 guidelines are pretty gray. The "2-4" and "5-7" guidelines are not so with certain payers. if you read the actual 1995 Guidelines, there are no such "numbers" given.

    Also keep in mind that you can also use the History and MDM to get a level 4, or 3.

    For an EPF exam using 95 guidelines, I look for 2-7 systems examined...not necessarily with much detail.

    For a detailed exam, I again look for 2-7 systems, but expecting one to be "detailed". Detailed being left up to interpretation, since there is no "official" definition.

    I'd look to your local mac to see if they offer guidelines on this...mine doesn't (WPS) but some do create their own "rules".
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

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