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Case Study
An established patient presents in the office for a recheck of the problem from a previous visit. The physician spends about 10 minutes reviewing the previous problem and would have been finished with the patient. However, the patient begins to talk about another problem he/she has been having. The discussion takes approximately 25 minutes and was regarding options and risks involved, possibility of medications and other forms of treatment. The patient's visit has lasted a total of 35 minutes. The physician would code the visit as:

Answer: c

The visit for the recheck of the previous problem alone would have been coded as a 99212 or 99213 based on the documentation meeting the required elements (2 of 3 key components). The discussion that followed the recheck has taken an additional 25 minutes of time which the provider should be reimbursed for. Due to the fact that the discussion was 50% or more of the total time of the visit, the provider could use "Time" as the determining factor in the selection of the level of service. A total of 35 minutes meets the time given for a Level 4 (99214) established patient visit. (It does not meet the time requirement of 40 minutes for a Level 5, 99215.) Therefore, by documenting the exact amount of time spent in discussion and what was discussed, the provider would be correct in billing a 99214.

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