EM Coding Alert
Look Closely at the HEM to Pick 99201 or 99202
Question: After my physician performed a problem-focused history and examination on a new 19-year-old patient along with a straightforward MDM, she continued with a preventive medicine encounter that included ordering a lab test and counseling.
I coded a 99202-25 with a 99385 for the same visit. I have coded this before on other new patients. The insurance company did an overpayment recovery on one of my past claims due to an incorrect payment they made on the 99202. Am I coding this correctly?
California Subscriber
Answer: The problem-focused history and examination with a straightforward MDM can only support 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history, a problem focused examination, and straightforward medical decision making) and may be the reason why the insurance company did an overpayment recovery on a past claim. If the physician clearly shows within the documentation the separation of these two services, they are both billable, just not at the level selected.
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