Cracking the Code

2021 Revised E/M Guidelines for Medical Decision Making (MDM)

When coding professional evaluation and management (E/M) cases for office and other outpatient visits (CPT code range 99202-99205; 99212-99215), it is important to understand the revised 2021 guidelines for medical decision making (MDM).

Rationale: low number and complexity of problems being addressed with acute, uncomplicated illness; moderate amount of data to be reviewed and analyzed with independent interpretation of prior x-ray performed at an outside facility; lastly, moderate risk of complication with prescription drug management. Based on 2/3 for MDM elements, this would constitute as a level 4 visit.

Q: Dr. Jones performs a follow-up visit for a 68-year-old male Medicare patient in his office for low back pain that is radiating towards the left leg. While deciding how to treat the patient, Dr. Jones performs an independent interpretation of prior x-ray results performed at an outside facility. The x-ray results provided a final impression of sciatica and herniated disc at L5-S1. With this information provided, Dr. Jones prescribes the patient with an NSAID for pain management. What is the most appropriate E/M level for this scenario?
A: 99214
Reference: AMA Revised MDM chart 2021
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