# Does 99214 = 99204 or 99205?



## kgarnette (Oct 24, 2013)

I had always been taught that a level 99214 visit would be the equivalent of a 99204 for a new patient.  However, another coder is telling me that 99214 would actually equal 99205 for a new patient.  Can anyone help clarify and direct me to documentation to support the finding?  Thanks!


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## jschmutz (Oct 24, 2013)

You can't just cross over an established pt to a NP visit.  You need to take the history, exam and MDM into account.  See below:

A 99214 that had a Det, Det, Mod would be a 99203
A 99214 that had a PF, Det, Mod would be a 99201
A 99214 that had a Comp, Det, Mod would be a 99203
A 99214 that had a Comp, Comp, Mod would be a 99204
A 99214 that had a Det, Det, High would be a 99203

I can't even think of a scenario where the components of a 99214 could ever equal a 99205.  Anyone want to try to come up with one (and remember the MDM can't exceed the level).

-Jen


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## jschmutz (Oct 24, 2013)

You can't just cross over an established pt to a NP visit.  You need to take the history, exam and MDM into account.  See below:

A 99214 that had a Det, Det, Mod would be a 99203
A 99214 that had a PF, Det, Mod would be a 99201
A 99214 that had a Comp, Det, Mod would be a 99203
A 99214 that had a Comp, Comp, Mod would be a 99204
A 99214 that had a Det, Det, High would be a 99203

I can't even think of a scenario where the components of a 99214 could ever equal a 99205.  Anyone want to try to come up with one (and remember the MDM can't exceed the level).

-Jen


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## MikeEnos (Oct 25, 2013)

Either you didn't understand them, or they don't know what they are talking about.  Jen spelled out all the possibilities above, but there is no scenario where a 99214 (which is a detailed history and exam, with moderate MDM complexity) would cross-walk to a 99205 (which is a comprehensive history and exam, with high complexity MDM.)  Even based on time, a 99214 is typically 25 minutes, a 99205 is 60.  Not even close.

In fact, I wouldn't even recommend your original anecdote.  99214 does not _*equal *_99204.  The complexity is the same (Moderate) but a 99214 requires a detailed history/exam whereas a 99204 requires a Comprehensive history/exam.


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