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Reply with quote  #1 
After taking this course, it feels like most if not all of my established office visits will be Level 4 as all of my patients have atleast 3 problems.

I am a Nephrologist.

My HPI and Examination is usually COMP level

A/P - EX 
CKD 3 - cr stable. Monitor
Essential HTN. BP stable. Continue antihypertensive.
Anemia in CKD. Hb at goal. No ESA indicated at present. Monitor.

So 3 problem points and Moderate risk factor with 2 chronic stable illness makes it 99214 established office visit.

I have not even added other problems - like proteinuria, secondary HPT, hyperlipidemia that I manage and comment or even DM Type 2 with diabetic nephropathy.

Thats 90% of my Nephrology practice with atleast 4-5 problem points as I comment on HTN, have to on DM as pt has diabetic nephropathy, on Lipids and make sure they meet goals as high prevalence of CAD in CKD patients.

So all of them should be level 4 - 99214..

Does every one bill it Level 4 or are physicians billing Level 3 as they have not taken the course

Am i missing something or will I be inviting Audit???

PS: same way in Medicine
DM Type 2 - at goal. Continue oral ADA
Essential HTN - BP stable. Continue BP meds.
Hyperlipidemia. Continue statin.
 
Above is a typical Medicare patient - so all of them will be billed 99214 for f/u every 3-6 months? Am i missing some thing or inviting Audit?

Will appreciate replies.

Thanks.

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Reply with quote  #2 
Correct me if I'm wrong but for established pt's only 2 of the 3 criteria need to be met and if your HPI and Exam are both  Comp with a MOD MDM, isn't that a 99215?

Our 99214 are usually detailed HPI, Detailed Exam and Mod MDM
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Reply with quote  #3 
Correct me if I'm wrong but for established pt's only 2 of the 3 criteria need to be met and if your HPI and Exam are both  Comp with a MOD MDM, isn't that a 99215? Or is it because the MDM should be the only driver for that code?

Our 99214 are usually detailed HPI, Detailed Exam and Mod MDM
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