CPT Help figuring out E/M level code for this scenario

[Laureen]

Answering this for Facebook user:

Question. I'm trying to figure out the E/M level code for this scenario.

A 45-year-old female, new patient went to the physician office because she was having substernal chest pain, shortness of breath and a deep cough. The physician did an expanded problem focused history, detailed exam and the medical decision-making was of moderate complexity. The physician performed a two-view chest x-ray. He performed an EKG which when interpreted showed supraventricular tachycardia.

I selected Office/Other Outpatient services, New Patient. But it says 3/3 required components. How do I determine which code is correct? E/M is the one section that always gets me

Using my method "Locate Your HEM in Time" you want to abstract the following:

Locate - what is the location or category/sub-category of EM -in this case it is Outpatient | New
H - what is the history level - in this case it is E for expanded problem focused
E - what is the exam level - in this case it is D for detailed
M - what is the medical decision making - in this case it is M for moderate
Time - was time a factor? - not in this case

So we have a EDM in the Office/New range of codes 99211-99215. Turn to your CPT manual to the Office codes - I have a copy and paste of them here

Looking at the first column which contains the NEW patient codes we see a EDM converts to a level 2|3|4. When it's 3 of 3 we code to the lowest - which would make it a level 2 or 99202.

Make sense?

Here are some related links:
https://www.cco.us/em-medical-coding-how-to-level-e-and-m-code-part-1-video/
https://www.cco.us/em-medical-coding-how-to-level-e-and-m-code-part-2-video/

And if you want the full training on this method worth 3 CEUs see this page https://www.cco.us/product/em-ceu-credits-online-course/

 

[Ruth Sheets]

Code 99211 is used for specific reasons and does not have a HEM (history, examination, and medical decision making) related to it. Learn more about when and when not to use 99211 by joining the CCO Club and viewing the August 2015 Q&A webinar video clip, "99211" where JoAnne Sheehan discusses what you need to know. You also get the transcript, answer sheets, and a chance to take a quiz to earn a 1.5 CEUs for the webinar by passing a 10 question quiz. Not only that, but you can access all the available resources for past webinars, too, and get more CEUs. It costs $19.95 per month to join the CCO Club.
CCO Club - http://cco.pe/1k0yNIf