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Maiu Posted Thu 26th of January, 2012 09:09:15 AM

Can E/M code 99204 be assigned if History is Comprehensive, PE is Detailed and Medical decision making is Low and patient has pneumonia?

SuperCoder Answered Wed 15th of February, 2012 11:19:45 AM

In order to qualify 99204, a patient should must have comprehensive history and exam with moderate complexity of MDM or should exceed the stated requirements (these three key component must). However, apart from these key components, you could bill this code based on time also.
As per Medicare guideline, when counseling and/or coordination of care dominates (more than 50%) the outpatient/office face-to-face physician/patient encounter or the inpatient floor/unit time, time is the key or controlling factor in selecting the level of E&M service.

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