To the Editor:

“How to Get All the 99214s You Deserve” by Emily Hill [October 2003, page 31] was accurate and illuminating. However, the coding guidelines for 99214 remain cumbersome and inefficient. In my experience, over 95 percent of visits to family physicians that could be coded 99214 fall into three easily identifiable scenarios. These scenarios should represent at least half of all visits in most family practices.

The first scenario is a patient with a new, significant problem; the second is a patient with three chronic problems; and the third is a patient with two chronic problems, one of which is worsening. Each scenario has at least three points on the number of diagnoses and management options and invariably meets the moderate-risk requirement, due to the complexity as well as the presence of medication management and/or invasive testing/therapy. This means that when presented with these three scenarios, one must perform either a detailed history or detailed exam (my auditors recommend 1995 guidelines, as noted in the article’s footnote) to code the visit a 99214.

Published guidelines, including those used by our own board, exist for most diseases. These guidelines encourage us to be thorough for the acute and chronic medical problems found in the scenarios above. Therefore, performing a detailed history and/or physical when patients present with these problems is appropriate for good medical care with the byproduct that we can bill and collect for doing our jobs well.

Physicians think in terms of patients with problems, as opposed to bits of information on a coding audit form. These scenarios should be much easier for practicing physicians to remember, as well as much easier for our resident physicians to learn.