99214 represents a code that is the second highest level of care for an established practice patient. This code ranks second among the most used CPT codes in the world. Internists use this code for 37% of office-based patients and should probably use it more often than they do.
The definition of 99214 is as follows:
Documentation for this encounter requires two out of three of the following:
1. Detailed history
2. Detailed examination
3. Medical decision making of moderate complexity
Or 25 minutes face-to-face with the patient if the coding is based on time. The corresponding documentation must be included.
A study has been conducted showing that from 2001 to 2010, physicians increased their use of the code 99214, which is a higher level and more lucrative billing code for evaluation and management (E/M) services over the course of the treatment of Medicare patients. During that time, the volume of Medicare payments for E/M services increased 48%, while spending for all Medicare Part B goods and services increased 43%. In 2010, E/M services represented 30% of all Medicare B spending.
Dramatic changes occurred with 99,213 and 99,214 visits. In 2001, the mid-range visit 99213 represented 54% of the pie and visit 99214 21%. By 2010, the proportion of 99213 had dropped to 46%, while that of 99214 stood at 36%, an increase of 15% from 2001.
The jump from 99213 to 99214 produced a huge increase in compensation. In 2010, Medicare paid an average of $97.35 for a 99214 visit, which is 50% more than the $64.80 for a 99213.
A suggested but unproven explanation for a higher E/M coding says that Medicare patients are sicker than they were in 2001, leading doctors to spend more time with patients to assess, diagnose, and manage their conditions.
A Florida doctor says an aging population means more complex care and a significant rise in obesity, which is leading to a rise in adult diabetes. Patients are also in many more mediations than in recent years.
Over the years, doctors have undercoded 99213 due to a lack of documentation and things to play it safe and settled for a lower reimbursement in the process. Even if they thoroughly documented the visit in their notes, they often coded 99213 to avoid being accused of overcoding, or the patient’s chart notes were incomplete, incomplete, and lacking in information. Any practice management consultant would say that such doctors “left money on the table.”
Undercoding has been a problem for primary care physicians who rely on E/M services for most of their income. So the push has been to make inferior coders not excessive coders, but accurate coders. Just a little food for thought…