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Optometry Coding & Billing Alert

Reader Question:
Base Coding on HEM, Not Visit Type

Question: I have a provider that saw a patient on Monday and coded a 99214. He then saw the same patient the next day for a follow up and coded a 99213. Is this correct coding or should the E/M for the follow-up visit be a 99212?

New Mexico Subscriber

Answer: Code 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making …) or 99213 (…which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity …) could be correct.

Office encounter coding is based on the documented levels of history, examination, and medical decision making. The patient is established so you’ll choose a code in the 99212-99215 series, based on those key elements. The fact that the encounter was a follow-up visit has not direct bearing on the code choice.