Middle of the Road 99203

According to EM University, in 2003 this code accounted for 39% of all documented office visits in 2003. I wonder why we don't have any further data on this. Wouldn't it be fantastic if we could see who was coding what and how often? Imagine if we could have a website that would present this information to physicians yearly and then match it against your rates? Well, there are some pay services that allow this for subscribers of their service....

I think you know how I feel about someone taking your data, compiling it with others AND THEN SELLING IT BACK TO YOU!

Frankly, that is just bull......I think it should either be outlawed OR we should be given FREE ACCESS to this.

It is after all, OUR DATA.

So with that little rant out. Let me tell you about a 99203

A 99203 is also called a Level 3 New Office Visit. What is it?

This office visit requires 3 key components

1. A Detailed History

2. A Detailed Examination

3. Medical Decision making of LOW complexity

Why do I point out Low complexity? Because, I think we may actually be coding too much of these and may instead need to be coding more 99204s and 99202s....

Let's examine what the definition of "Detailed" is.

"Detailed History"-Requires a Chief Complaint (CC), "extended" HPI, problem pertinent Review of Systems (ROS) which is "extended" tp incude a limited review of:

A. Family History

B. Social History

C. Past Medical History 

All directly related to patient's problem.....

2. Detailed Examination-Requires an "Extended" examination of the affected body area or organ system AND other symptomatic or related organ systems.....

"Extended Examination"- requires 12 data points/bullets.

If you want to learn more about bullets you can see it here.

3. Lastly, Medical Decision Making of "LOW COMPLEXITY"

Which requires

1. Limited number of Diagnoses or Management Options

2. Limited amount of data to review

3. Low complexity of data to review

4. Disease with low morbidity or mortality

So the question remains...."What does this look like?"

Initial offive visit for a 67 year old woman with hypertension, new to the area. She has had no problems with her BP while on a diuretic and home bp monitoring. She brings in her log.

You are expected to do the same things that you would for a 99202

So why do I think we are using this code too much? Here's the question.....would you do such a thorough History or Physical in a patient with well controlled HTN?

Probably not, which would then bump you down to a 99202. 

But what about well controlled diabetes? The mortality and morbidity is higher and you would do more work.....thus a 99204, which I will cover tomorrow......

You see, by choosing middle of the road, we may be coding wrong......

Want to join us? Email us at modifier25@gmail.com You can learn the system and be better at coding too. This may save you 80-100k per year.....