How to Bill 99214

From UofL General Peds

In order to bill 99214 you must document according to the standard in:

2 of these 3 elements:

1. Detailed History

Appropriate history includes the chief complaint plus all 3 of these:

History of Presenting Illness: 4 elements including location, duration, quality, timing, severity, or context.

Past, Family, or Social History: Only need 1 of these, and automated listing of drug allergies or medications counts.

Review of Systems: 2 or more pertinent elements.

2. Detailed Physical Examination

Vitals signs plus eleven physical exam elements in at least two organ systems.

3. Moderate Medical Decision Making

Moderate medical decision making requires 2 of the following 3 elements:

1. Three Problem Points

  • Self-limited or minor problems (maximum of 2): 1 point each
  • Established problem, stable or improving: 1 point each
  • Established problem, worsening: 2 points each
  • New problem, with no additional work-up planned: 3 points
  • New problem, with additional work-up planned: 4 points

2. Three Data Points

  • Review or order clinical lab tests: 1 point
  • Review or order radiology: 1 point
  • Review or order medicine test (PFTs, EKG, cardiac echo): 1 point
  • Discuss test with performing physician: 1 point
  • Independent review of image, tracing, or specimen: 2 points
  • Decision to obtain old records: 1 point
  • Review and summation of old records: 2 points

3. Moderate Risk

Moderate risk is met if any one of the following is true:

  • One or more chronic illness, with mild exacerbation, progression, or side effects of treatment (e.g. adverse effects from ADHD medication)
  • Two or more stable chronic illnesses
  • Undiagnosed new problem, with uncertain prognosis (e.g. lump in breast)
  • Acute illness, with systemic symptoms
  • Acute complicated injury (e.g., head injury, with brief loss of consciousness)
  • Prescription drug management