Wiki To what extent does MDM contribute to level of visit?

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zora2002

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Office visit for an established patient; EPF history, EPF exam, MC decision making. Am I able to code 99214 due to MDM is highest? My understanding is that 99213 is to be coded due to 2 out of 3 (one of those being MDM) do not constitute 99214. I recieved feedback recently that 99214 is applicable due to MDM trumps other two categpories. Can I please get some feedback on this? Thanks!
 
As often happens, maybe you are thinking of medical "necessity" instead of medical "decision making" trumping over the history and exam. You are correct with 99213 when following E/M coding guidelines. The documentation guidelines will say that medical NECESSITY will be the overarching criteria used to determine the correct code. Just having a moderate level of MDM will not necessarily mean 99214 can be assigned. Yes, the History and/or exam should meet that standard but the medical necessity needs to be met as well.
 
Thank you for your feedback Twins. Do you know where I would be able to locate documentaion that supports this? I had no luck with my internet search.
 
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