99223 Higher CPT

[mrachana160894@gmail.com]

As per the EMR documentation, the Medical Decision Making (MDM) time should be higher due to the complexity of the case, specifically in relation to the patient's conditions. The case involved:

1. Acute kidney failure
2. Chronic illnesses including lung cancer and congestive heart failure (CHF)

Additionally, the patient received appropriate treatment for these conditions during the visit.
Given the complexity and the 75-minute MDM time documented, So should we downgrade 99223 to 99222? because getting MC. UHC denial for 99223

 

[csperoni]

It seems the service was properly leveled based on time, regardless of MDM leveling. Downgrading the visit would be incorrect. It should be appealed.