Forum - Questions & Answers

Jun 19th, 2014 - Lyn7

What are the required elements for 99214

Jun 19th, 2014 - Codapedia Editor 1,399 

re: What are the required elements for 99214

There's an article on Codapedia for that.

http://codapedia.com/article_251_99214-Established-patient-visit.cfm

Jun 19th, 2014 - CodapediaMsgBoard 96 

re: What are the required elements for 99214

The article is a good reference. Basically, you need to have 2/3 of history, exam and medical decision-making at certain levels because it is an established patient encounter.

By CPT® rule, you can use any 2/3, though it is often a best practice to ensure you are using medical decision-making to support the medical necessity of the service itself.

To count a history that supports 99214, you need:
HPI: 4 or more elements
ROS: Detailed of 2-7 systems (typically this means you would have documentation of at least 3 aspects of one system)
Past Family and Social History: 1 area of past medical, family or social history.

To count the exam that supports 99214:
1995 E/M: Documentation of 2-7 organ systems OR body areas, usually with the documentation of at least 2-3 areas of the most directly impacted organ systems or body areas. You typically cannot combine organ systems AND body areas when counting exam elements
1997 E/M: At least two bullet items from six different organ systems or 12 bullets from two or more organ systems.

There are specialty-specific 1997 exams that I won't address in detail.

For the medical decision-making to count, it needs to be of moderate complexity. This is usually achieved through prescription drug management, treatment of multiple stable chronic illnesses, a problem that is new to the provider with additional workup or an uncertain prognosis, or some minor surgeries with risk factors or major surgeries without risk factors. Ordering of diagnostic endoscopies is another way to achieve moderate medical decision-making. You can also do so, using audit tools such as the Marshfield tool, when the patient is having lab tests, radiology tests and medicine section tests ordered.



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