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Pediatric Coding Alert

Reader Question:

E/M Code Assignment Is Unrelated to Established Problem

Published on Fri Jan 13, 2012

Question: We recently finished our first internal audit and found a potential issue: One of the doctors told me that they only chose level 99212 when it is a follow-up from a previous visit.  He chooses levels 99213 and above for everything else. I do not believe it is that simple because I thought even if it was not a follow-up visit, something like a minor cold might warrant 99212. Can you advise?Answer: You are correct. Not only can a follow-up problem-oriented visit for an established patient warrant a "low-level" code such as 99211 or 99212, but your coding should never hinge solely on whether a problem is new.The selection of an E/M level should be based on documentation and medical necessity.  If you have documentation that supports a comprehensive history and a comprehensive exam but you are sending the patient home with a plan of rest and symptomatic treatment with mention of [...]
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