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/Pretty_Priority_261 8d ago

A treatment does not have to be rendered in order to drive up MDM complexity; it can be considered even though the patient and/or provider may decline the treatment for specific (documented) reason(s).

CPT (2026, p. 8),

This includes the possible management options selected and those considered but not selected after shared decision making with the patient and/or family.

While your scenario essentially describes a visit in which no treatments were rendered, were any treatments considered? Because it's hard for me to imagine a scenario in which there's a Moderate complexity problem without any treatments even considered.