Coding is all about being specific. For example, to qualify for a 99203, the history must have 1-3 elements, the physical must have 6-11 elements, and the medical decision making must be low-complexity. “Low complexity” is defined partially by a point system for data, partially by a point system for diagnoses, and partially by the level of risk (which is determined from a table). Other codes have different criteria. As you can see, coding can quickly make your head spin and wonder how anyone can decide this all in a timely manner.
Fortunately, for most beginners, we can simplify this greatly. Most office visits qualify for either 99213 or 99214. Since they are so similar, we can quickly come up with a few criteria that let us know when we qualify for a 99214; otherwise, we likely have a 99213 office visit. Both 99213 and 99214 are for patients who are not new to your care, but for established patients only. New patients are similar, but we will discuss that later. This is the best starting place for most residents.
Medical Coding and Billing For Residents 