Wiki 3 different levels exam

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CodingMari

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I have another question hopefully this will clear up the CONFUSIONS in my head!!1

So, if patient has a detail history, EPF exam, Moderate risk - I can code a 99214
other example is Detail history, Problem Focus exam and Moderate risk - I can throw out the to lowest and code the highest correct?

when exactly do i use that rule? is it just when I have 3 different levels of exam ? did i just answer my question? HELP!
 
Use the throw out rule when you need 2/3. Throw out the lowest and the highest one. So you end up coding the middle one. With your first example it actually comes out the same. You would throw out the Problem focused and EITHER the EPF exam or Moderate risk. So, you end up with a 99214. On your second throw out your problem focused exam and EITHER Detailed history or Moderate risk. So, this one comes to 99214 as well.

Hope that helps clear it up.

Machelle Freeman, CPC
 
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The 2 of 3 requirement is part of the code descriptions in the CPT book, for established patient office and outpatient visits, or for other E&M codes when applicable.
 
I'm sorry I asked the wrong question again.

I meant to ask where does it state we can throw out to 2 lowest and keep the highest.

Detail HPI
EPF Exam
Low MDM I can throw out the two lowest and keep the hightest.

PF HPI
detail exam
High MDM ??

How do I know which one to keep?
 
I'm sorry I asked the wrong question again.

I meant to ask where does it state we can throw out to 2 lowest and keep the highest.

Detail HPI
EPF Exam
Low MDM I can throw out the two lowest and keep the hightest.

PF HPI
detail exam
High MDM ??

How do I know which one to keep?
 
In the 2016 CPT book page 10 it states "for the following categories/subcategories, two of the three key components must meet or exceed the stated requirements to qualify for the particular level of E/M service". In your example of Detailed HPI, EPF Exam, Low MDM, you will get a 99213. You throw out the low MDM because you have a EPF exam and Detailed HPI. The Detailed HPI exceeds the EPF exam by 1 level, so you've met/exceeded the requirements stated above. The second example would be a 99214 because you throw out the PF HPI, use the detailed exam and high MDM. The high MDM exceeds the detailed exam by 1 level. Hope that helps.
 
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