Level 5 Office E/M Code

Question:

I was told that if I recommend surgery then I can automatically bill 99205 or 99215. This seems too good to be true. Please advise.

Answer:

You’re right – you’ve been given inaccurate information. Remember, office visit codes (99202 – 99205, 99212 – 99215) require meeting or exceeding two of the three Medical Decision Making elements. The third element, Risk, is where recommending surgery is relevant. You still need to meet one of the remaining two elements – Problems Addressed or Data – to get to the level 5 codes which require high Problems Addressed, extensive Data, and high Risk.