CCO Admin asked:
Stumped on this question:
"Emily; 23-months-old; has severe diarrhea and vomiting. She is extremely dehydrated. She is brought to the outpatient clinic to see her pediatrician. The patients pediatrician performs an EXPANDED PROBLEM FOCUSED HISTORY that includes four elements for an extended HPI; five elements for an extended ROS; and no PFSH. He performs a general multi-system COMPREHENSIVE EXAM of eight organ systems. The physician orders labs to be performed in the office including carbon dioxide; chloride; potassium; and sodium. The nurse performs a venipuncture to obtain the blood sample. The physician diagnoses the patient with dehydration and instructs the mother to increase fluid intake to hydrate the baby. The MEDICAL DECISION MAKING is moderate.
Correct Answer is: 99214-25; 36415; 80051; E86.0; R11.10; R19.7
I do not understand why the E/M code is 99214-25 and not 99213-25. Can someone explain in full why 99214-25 is correct? Thank you.
Answer:
In your example; you have as follows:
E (history)
C (exam)
M (MDM).
Since; this is an established PT; only 2 of 3 elements are required and in this case you will throw out the lowest; so 99213 can be thrown out as the elements are E;E; L for 99213.
Now with code 99214 the elements are as follows:
D (history)
D (exam)
M (MDM)
Then with code 99215 the elements are as follows:
C (history)
C (exam)
H (MDM)
Since all 3 components have not been met; we level; which we are left with a Comprehensive exam and medium MDM which we have to level again. The MDM did not reach a high but did a medium; though the exam reached a comprehensive; the MDM did not reach a high so the correct code is 99214.
Stumped on this question:
"Emily; 23-months-old; has severe diarrhea and vomiting. She is extremely dehydrated. She is brought to the outpatient clinic to see her pediatrician. The patients pediatrician performs an EXPANDED PROBLEM FOCUSED HISTORY that includes four elements for an extended HPI; five elements for an extended ROS; and no PFSH. He performs a general multi-system COMPREHENSIVE EXAM of eight organ systems. The physician orders labs to be performed in the office including carbon dioxide; chloride; potassium; and sodium. The nurse performs a venipuncture to obtain the blood sample. The physician diagnoses the patient with dehydration and instructs the mother to increase fluid intake to hydrate the baby. The MEDICAL DECISION MAKING is moderate.
Correct Answer is: 99214-25; 36415; 80051; E86.0; R11.10; R19.7
I do not understand why the E/M code is 99214-25 and not 99213-25. Can someone explain in full why 99214-25 is correct? Thank you.
Answer:
In your example; you have as follows:
E (history)
C (exam)
M (MDM).
Since; this is an established PT; only 2 of 3 elements are required and in this case you will throw out the lowest; so 99213 can be thrown out as the elements are E;E; L for 99213.
Now with code 99214 the elements are as follows:
D (history)
D (exam)
M (MDM)
Then with code 99215 the elements are as follows:
C (history)
C (exam)
H (MDM)
Since all 3 components have not been met; we level; which we are left with a Comprehensive exam and medium MDM which we have to level again. The MDM did not reach a high but did a medium; though the exam reached a comprehensive; the MDM did not reach a high so the correct code is 99214.
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