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CodingMari

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establish outpatient visit.

I have a question in regards to CPT code 99214 in order to qualify for this level 4 elements of the HPI or 3 Chronic conditions plus one pertinent PFSH.

so in order for me to select this code i have to have 1 of the PFSH?? What if I have a detail HPI & ROS with no PFSH is this still considered 99213?
 
the reason I am asking this question is because I often see a Detail history = 4 elements or 3 chronic conditions and 2 ROS mention, a Moderate for risk and and Detail exam. but no mention of PFSH. It says i need 2 out of 3 Does this qualify 99214?

I also often see a Detail HPI NO PFSH EPF exam and moderate risk. Again will this qualify for 99214?
 
Hi daedolos,

thank you for link. some what helpful because the problem I am having is trying to determine the level for example

patient has 3 Chronic conditions the Exam was Problem focus MDM is moderate. according to CPT guidelines i need 2 out of three which means I qualify for 99214 but the descriptions for a 99214 requires a PFSH

I'm literally pulling my hairs here....
 
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Your HPI and PFSH stats dictate the Hx level. Figure it out from there. The chart refers to page 8 then go back to page 9 to see if that still qualifies you for 99214.

Peace
@_*
 
saket1707 said:
Yes, You can go for 99214.
Click to expand...

Hi,

I appreciate the feed back. I learn something new everyday with the help of the AAPC community..

So here I am thinking if there is no mention of PFSH i cant bill a 99214. I started to scratch my head to the point where I was stressing my self over the whole 2 out of 3 but no PFSH. This is great!!

HPI < 3 Chronic conditions no mention of PFSH!
Exam < PF
MDM< MODERATE = service qualifies for 99214 :)
 
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I disagree - if your exam is PF, and MDM is moderate, then you need at least a detailed history to bill 99214. You do need 2 out of 3 of these: detailed history, detailed exam and moderate MDM. Since you do not have a detailed exam, you need a detailed history or higher.

A detailed history requires: 1) an extended HPI (you have this with 3 chronic conditions), and 2) extended ROS and 3) a problem-pertinent PFSH. So in addition to your HPI, you also need a ROS of 2-9 systems and at least one element of PFSH.

Hope this helps.
 
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Oh okay....

so either way I will need at least one element of the PFSH to meet that level of care.

and this is because the HPI ROS PFHS has to be detailed

but its confusing because it says or "3 chronic condition" so what I am understanding is even if the patient has 3 Chronic condition EP exam Moderate MDM I will have to drop it to 99213 because there is 1 element of the PFSH missing?
 
2 of 3 components

I have another question hopefully this will clear out my CONFUSIONS!!

So, if patient has a detail history, EPF exam, low 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!
 
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