A 99214 requires two of three key components: a detailed history, a detailed exam, or moderate medical decision making. Some payers require that medical decision making be one of the two key components because it drives medical necessity.
Moderate medical decision making, in turn, requires two of three components: diagnoses or management options (three points), data reviewed (three points), or moderate risk.
Because the risk component doesn’t have points assigned to it, it is more subjective and difficult to identify, but here’s what to look for in moderate risk consistent with a 99214:
Read the full FPM article: “99213 or 99214? Three Tips for Navigating the Coding Conundrum.”
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