Wiki clarification on 2/3 req'd elements on Est pt exam

[bungalowgirl]

I am looking at an EST pt's office note where the patient is coming in (Chief Complaint/Reason4Visit) for a follow up on ears/tubes 4 mos after tube surgery. The Dr also recorded the PFSH, and a complete review of systems, BUT NO EXAM. He billed a 99212.
Now, I know what he's thinking- that for an est pt visit, he only needs 2 of 3 elements. My question is, is that absolute? OR, does he need SOME level of exam (even 1-2 bullets (on '97 exam which is what I typically go by)? BTW, there was no mention of time spent...
Any elaboration on this is welcomed- I see this type note every few months and want to be sure. Thanks!

 

[madsmacpc]

NO exam is necessary for an established patient. You can focus your elements on the HPI and MDM for your level. A provider may come in and just review labs and scans and talk to the patient... they don't necessarily have to exam the patient each time. I hope this helps.

 

[MarcusM]

I find it hard to believe the ENT did not even look into the ears to make sure the tubes were in place without inflammation, irritation, etc. Maybe he takes this as a given since it was a follow up on tube placement(s). You may want to double check with your providers to make sure they are documenting correctly as Medicare consistently states if it is not written down, then it never happened.