Wiki 99213 or 99214

[Nancy Klein]

Hello group,
Patient has 1) HTN and 2) microalbumin
Patient visit is for a re-check of these 2 conditions.
HTN is well controlled with medication.
Microalbumin is better since it’s original diagnosis 1 year ago.
Prescription refills are given at the visit.
Would a 99214 be justified? (2 stable chronic illnesses and prescription drug mgmt.).
I’m Not sure which category the microalbumin would fall under. Either Acute uncomplicated (low complexity) which would make the visit a 99213 due to 1 stable chronic and 1 acute illness. Or would the microalbumin be a Stable chronic illness since patient has had it for over a year. If chronic, then patent would have 2 chronic stable illnesses (moderate) plus script mgmt which would qualify as a 99214.
Thank you in advance!

 

[jkyles]

Hi there, duration does not determine stability. You'll need to ask the treating provider for more information.

From the guidelines:

“Stable” for the purposes of categorizing MDM is defined by the specific treatment goals for an individual patient. A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function.

 

[Nancy Klein]

Hi there, duration does not determine stability. You'll need to ask the treating provider for more information.

From the guidelines:

“Stable” for the purposes of categorizing MDM is defined by the specific treatment goals for an individual patient. A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function.

So-If the microalbumin goal is to be eliminated and is only at improved- how would you classify the illness? As Low or moderate? As an Acute illness or chronic illness?

 

[jkyles]

I'm not a medical provider, but if the purpose of the microalbumin test is to watch for signs of kidney failure, then low complexity does not seem to be appropriate. However, you should ask the treating provider to confirm and remind them that they need to include more detail in their notes.

 

[natashalage]

Hello, I am a new coder, still learning but I will code it as moderate MDM. Pt is coming to re- assess his two Existing conditions that he has had for a Year. For Dx column, it’s moderate. For the Risk, it’s Rx- moderate = 99214. I am always eager to learn.