EM Coding Alert
Save 99318 for Annual Assessments
Question:Our physician met a patient in a nursing facility in March and then saw the patient again in June at the same nursing facility. During the June visit, she evaluated the patient for a new problem and documented a detailed history and examination with medical decision making (MDM) of low complexity. Should I report 99318?
Florida Subscriber
Answer: You need to understand the intent of the provider’s encounter with the patient to determine the correct coding.
Because the doctor saw the patient for a problem-oriented visit, rather than an annual assessment, 99318 (Evaluation and management of a patient involving an annual nursing facility assessment, which requires these 3 key components: a detailed interval history; a comprehensive examination; and medical decision making that is of low to moderate complexity) is not the correct code for the June E/M service.
Instead, since the history and exam meet the requirements for two of the key components, you will choose 99309 (Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a detailed interval history; a detailed examination; Medicaldecision making of moderate complexity).
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