What code is applicable when a comprehensive history and examination are performed for an established patient with high complexity medical decision making?

Prepare for the Professional Practical Experience Test. Studying with our comprehensive flashcards and multiple choice questions will maximize your chances of success. Each question is designed with hints and explanations to ensure your readiness. Achieve success with confidence!

When coding for a comprehensive history and examination for an established patient with high complexity medical decision making, the appropriate code is 99215. This code is part of the Evaluation and Management (E/M) service codes and specifically denotes a visit that requires a thorough assessment and involves a significantly complex medical decision-making process.

In this context, a comprehensive history means that the clinician gathers extensive information about the patient’s health history, current health status, and any relevant socio-economic factors. A comprehensive examination involves a detailed physical examination that assesses multiple body systems or requires the review of complex management issues. High complexity medical decision making indicates that the clinician has to review numerous factors such as diagnosis, risk of complications, and the need for additional testing or specialist referral.

The other codes do not meet the criteria for this specific scenario. For instance, the option pertaining to lower complexity visits or different patient statuses would not suffice in representing the extensive services rendered in this particular case, making 99215 the most suitable choice based on the requirements outlined.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy