I recently attended a presentation on coding sick visits, and thought I would take some time to address it.
Too many doctors are undercoding their sick visits. It’s hard enough to get paid for the work you do, but this is an easy thing you can do to get credit for the work you are doing. If you are average, then about 35% of your visits should be 99214s.
Let’s dust off the old CPT code book and take a look at what makes each visit earn its codes.
Now, I am not going to recreate Donell Holle’s amazing presentation here, but if you get the chance to go see her speak, you should take advantage of the opportunity. Here are a few things to think about when making a decision about 99213 vs 99214.
History: Reviewing more than one system or any past medical, family or social history makes it a detailed history (component of 99214).
Exam: This is a little more subjective. Reviewing more than one system takes you to an expanded exam, but if it is an extended review of systems, if may qualify as detailed (component for 99214).
Medical Decision Making: Reviewing another physician’s notes or an old chart is a component of moderate complexity as is writing a prescription.
Time: This is only a consideration if over 50% of the visit was spent counseling or coordinating care. In general time is 15 minutes for a 99213 and 25 minutes for a 99214.
These are some guidelines to consider when making a coding decision. I hope this helps. I do have a one-pager that has helped clients increase their 99214s. Email me (firstname.lastname@example.org) for a copy.