Pediatric Coding Alert

Reader Question:

E/M Code Assignment Is Unrelated to Established Problem

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 [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Pediatric Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.