Medical Coding 99213 Vs 99214 Cheat Sheet

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Medical coding 99213 vs 99214 cheat sheet. The following tips can help you. Of course in cases where the history isn t detailed or the medical decision making isn t moderate but you provided and documented a high level exam it would be well worth your trouble to count your findings. In order to assign a preventative code a comprehensive. One of the most confounding aspects of evaluation and management e m coding is the distinction between a 99213 and a 99214 established patient office visit.

Choosing a proper office visit code can become confusing unless one understands the rules separating preventative medicine and evaluation and management coding. Evaluation and management codes by rachel m. And coding 99214 visits suddenly becomes easier than you may have thought. A 99214 requires a review of only two.

Preventative medicine codes are meant only for the reporting of asymptomatic patients. It would not be medically necessary or appropriate to bill a higher level of service of evaluation and management service when a lower level of service is warran ted. With these two codes accounting for such a large proportion of office visits and with a difference of about 35 per visit using the national average medicare allowed amounts the distinction. Medicare s guide lines indicate that 99213 should be used for visits requiring low com plexity medical decision making.

Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a cpt code. There are a number of myths that surround coding of established patient low complexity cpt 99213 and moderate complexity cpt 99214 visits. The volume of documentation should not be the primary influence upon which a specific level of. Perhaps one reason physicians balk at the prospect of coding 99214 more often is the perception that the documentation is considerably more burdensome than for 99213.

In primary care cms has suggested that the 99213 visit should be the most common code used with 99214 visits representing roughly a third of the number of 99213 coded. A 99214 requires only two of the three major criteria.