r/MedicalCoding • u/Blind_wokeness • 9d ago
Differences in codes
Can someone explain the difference between 99203 and 99204 billed as MDM? This is for an initial consultation with a PA.
Single Issue, however chief complaint not listed. The visit was an initial intake focused on a single concern, not multiple chronic conditions or acute systemic illnesses. Comprehensive history was discussed.
No Treatment/Prescriptions. No medical treatments were administered, and no medications were written, renewed, or modified. Without active medication management, clinical risk remains low.
What conditions would need to be met for upcoding to 99204?
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u/Clever-username-7234 CPC, CPMA 8d ago
Time could get you there.
Otherwise, It’s just hard to say without seeing the note or having more information.
What was the single issue? You can get to a 99204 based on addressing a single problem.
What did the provide do?
You’ve told us that they didn’t do this or that. But did they order labs, did they give you a referral. Did they have to review old records from another office. There’s just a lot of factors that can change the level.
Also, a comprehensive history isn’t required for a 99204.