Answer and Analysis

You see an established office patient with stable HTN and diabetes. You make no changes to medications and order a BMP, lipid panel and HgbA1c for the next visit in 3 months. Total time spent is 15 minutes.

Correct Answer: 99214

For these encounters, the level of care may be selected based on time or based on the MDM. If coding based on time, this visit would only qualify for the 99212 visit. On the other hand, this encounter requires moderate complexity MDM based on the problems addressed (two stable chronic illnesses) and the data reviewed (ordering of three unique tests) as outlined below. Moderate complexity MDM points us toward the 99214 level of care, which is the correct code for this encounter.

Requires two out of three dimensions to qualify