AMA CPT® Assistant - 1997 Issue 1 (January)
Evaluation and Management, 99213, 84153 (Q&A) (January 1997)
January 1997 page 10 Coding Consultation Evaluation and Management, 99213, 84153 (Q&A) Question A 65-year-old male who never goes to the doctor, comes in with bronchitis/cold/flu symptoms. Doctor works him up for bronchitis, and meets the key components for E/M code 99213 . The doctor feels it is important to do a PSA, but patient refuses the other components of a preventive visit. How do you code this? Do you use just the E/M Office/Outpatient visit plus code the PSA, or do you code E/M Office/Outpatient visit, preventive medicine, and/or PSA test with a modifier? AMA Comment The Preventive...
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Article Overview
This short AMA coding Q&A explains the general distinction between office/outpatient evaluation and management services, preventive medicine services, and a separately reported PSA lab test in a symptomatic patient scenario. It is relevant to coders, billers, and compliance staff who work with physician office encounters, laboratory ordering, and CPT/diagnosis code reporting guidance from the CPT Assistant era.
Why This Topic Matters
The article helps readers understand how a single encounter may involve different service categories and why visit intent matters in high-level coding decisions. It is useful for avoiding confusion between preventive and problem-oriented reporting in physician office settings.
Article Sections
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January 1997 page 10
Publication location and issue context for the Q&A content.
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Coding Consultation
Editorial context introducing the coding question and response format.
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Question
A physician office encounter scenario is presented and the coding options are asked about in general terms.
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AMA Comment
An AMA response explains the broad distinction between service categories and discusses how the reported laboratory test and diagnosis context are addressed.
What You Will Learn
- How the article distinguishes problem-oriented office/outpatient services from preventive medicine services
- How a separately ordered laboratory test is discussed in the context of an office visit
- What kinds of diagnosis context are referenced for a symptomatic visit
- How the Q&A frames coding decisions for a physician office encounter
Who Should Read This
- Medical coders
- Medical billers
- Compliance professionals
- Physician office staff
- Revenue cycle teams
Codes Discussed
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