General Surgery Coding Alert

Question: I think my surgeons frequently perform office visits that warrant coding at level four or higher, but I-m concerned about raising red flags for upcoding. Would you explain how I should determine when I-m justified in billing level four?

Tennessee Subscriber

 Answer: Your first step in choosing the correct code is to look at the differences in the descriptors for 99213 and 99214:

-  99213 -- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

-  99214 -- [...]