In a previous column on the basics of coding, we discussed having a “reference code” — sort of a gold standard by which one can measure other services. Because 99213 is the most commonly billed code, this is the ideal reference.

If a pediatrician performs a service that involves less work, it should be assigned a code with a lesser value — ie, 99212 (99211 is for a patient visit that does not require the input of a physician and is frequently referred to as a “nurse visit”). Conversely, if the service is more time consuming and results in more work, a code that provides increased compensation usually is selected (this means 99214 or 99215). The question then becomes, “How much extra work beyond the 99213 is needed before a code with a higher level and payment is selected?” For the answer, turn to the “rule book of...

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