Question

You have been working for an internal medicine office for several months. There are 5 providers in total and all of them seem very dedicated to their patients and seem to provide quality care. The youngest provider Dr. Lewis (he just completed his residency 6 months ago), seems to be coding many of the more routine office visits at a high level (99214) as opposed to the other providers with comparable visits usually coded at 99212 or 99213. After reviewing the notes for several visits that have been coded at 99214, you believe that the provider is over-coding these visits. Dr. Lewis is very open to suggestions from all co-workers and repeatedly indicates that he knows he is a “rookie” and he wants to do thing right.

Write out a conversation between you and the doctor (Dr. Lewis) voicing your concern about how he is coding his visits.

Answer 1

1.99214 CPT code is indicated for an outpatient visit for the evaluation of and management of patient which requires atleast 2 of 3 componenets:detailed history,detailed examination and medical decision making.
-99214 is a level four code that can be used only for new patient with detailed examination.

2.99212 or 99213 is used to code to the patient as mid level outpatient or inpatient visit.
-CPT code 99212 or 99213 should not be used for patient who has no history. It is used for a existing patient has a scheduled appointment for a routine examination.