Wiki Epf exam detail hpi low mdm?

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CodingMari

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Are there rules to determine the level of care when the HPI is details, Exam is EPF, and the MDM is low. How do we determine what is the correct level of care?
 
It doesn't need to exactly meet the three key components, it can meet or exceed. If new patient office visit you code to the lowest so 99202 since you can meet the exam component and exceed on history & MDM. You cant bill 99203 since exam level is not high enough.
 
For some reason I am still confuse.

So your saying if the exam does not meet the HPI or ROS because is a PF exam I cant bill a 99203 I have to bill 99202 .. so I can high a high MDM (met 2 of the 3) and I have a PF exam and a detail exam I can only bill 99202? did I make any sense?
 
For new patient where you need to meet or exceed on 3 of 3 key components.

for 99203 I bolded the levels that meet or exceed what is specified by the CPT code

History
Problem focused < Expanded Problem Focused < Detailed < Comprehensive

Exam
Problem focused < Expanded Problem Focused < Detailed < Comprehensive

Medical Decision Making
Straightforward < Low < Medium < High


In your situation you meet or exceed on History and MDM but the Exam is is too low, you only have 2 of 3 on 99203. You then need to look the next level down to see if you meet or exceed on all three.





99202, I bolded the levels that meet or exceed what is specified by the CPT code

History
Problem focused < Expanded Problem Focused < Detailed < Comprehensive

Exam
Problem focused < Expanded Problem Focused < Detailed < Comprehensive

Medical Decision Making

Straightforward < Low < Medium < High

Since you now meet or exceed on all three levels this is the highest you can go
 
I don't get it. is this normal?

I have come across

PF HPI
NO ROS
EPF Exam
Moderate MDM

I am having such a hard time trying to figure the meet or exceed.
 
CodingMari said:
I don't get it. is this normal?

I have come across

PF HPI
NO ROS
EPF Exam
Moderate MDM

I am having such a hard time trying to figure the meet or exceed.
Click to expand...

HPI/ROS are part of history

History from lowest to highest is

Problem focused < Expanded Problem Focused < Detailed < Comprehensive

So if is a new patient you cant go any higher than a 99201 which is the lowest level of E&M since 99202 requires at least a EPF history
 
So I was under the impression that the ROS is when the provider ask the patient questions in regards to NO SOB NO V/D ?

I usually see patient present with complains of itchy red eyes for 2 days, patient has really bad allergies, states both eyes became red and in the am eyes are crusty.

How do I get an ROS from that? I only gathered location, quality, duration and associated signs and symptoms.

so if my HPI/ROS is PF, Exam COMP and LOW MDM I would still bill a 99202? is that right?
 
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