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I'm looking for someone to clarify coding for outpatient.
Most typical codes used are 99213 and 99214 or 99203-05. For the higher codes the amount of energy needed to make sure all requirements are met is quite high (particularly for 99215 (which I end up never billing for due to this)). But also 99214 needs more attention than when typing up for 99213.
But I have discovered that if 50% of visit is dominated by counseling/coordination of care (and its documented this way) the "physician must bill the highest level of code in the code family".
--there is no mention that say to bill a 99214 (when 50% is dominated by counseling in a 30min session) the coding needs to meet criteria for a 99214 code. (since billing becomes time-based).
So for example it seems it is much easier to document for a 30min followup a 99214 code by including that 50% of visit was documented by counseling (and including total time spent), than trying to make sure all the documentation points are hit for a 99214 (without including that text).
But also this makes it possible to more easily code 99205 for 60min new patient appointments. or a 99215 if followup ends up being say 65min.
Or am I getting this all wrong?
I used the MinMatters prolonged service codes newsletter. https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/mm5972.pdf
Most typical codes used are 99213 and 99214 or 99203-05. For the higher codes the amount of energy needed to make sure all requirements are met is quite high (particularly for 99215 (which I end up never billing for due to this)). But also 99214 needs more attention than when typing up for 99213.
But I have discovered that if 50% of visit is dominated by counseling/coordination of care (and its documented this way) the "physician must bill the highest level of code in the code family".
--there is no mention that say to bill a 99214 (when 50% is dominated by counseling in a 30min session) the coding needs to meet criteria for a 99214 code. (since billing becomes time-based).
So for example it seems it is much easier to document for a 30min followup a 99214 code by including that 50% of visit was documented by counseling (and including total time spent), than trying to make sure all the documentation points are hit for a 99214 (without including that text).
But also this makes it possible to more easily code 99205 for 60min new patient appointments. or a 99215 if followup ends up being say 65min.
Or am I getting this all wrong?
I used the MinMatters prolonged service codes newsletter. https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/mm5972.pdf
