High Risk
From AAFP 2014
“High risk is associated with high complexity medical decision-making. High risk could be associated with visits involving patients who have severe exacerbations of their problems or acute injuries that pose a threat to bodily functions. Diagnostic procedures or management options associated with highly complex care include cardiac electrophysiology studies, diagnostic endoscopy, discography, major surgery, parenteral controlled substances, or drug therapy with the need for intensive monitoring.
For example, a high-risk visit might involve a patient who requires:
- a parenteral medication in the office such as an injection for a migraine,
- supplementary fast-acting insulin for hyperosmolar hyperglycemia cases, or
- warfarin adjustment due to a supratherapeutic international normalized ratio.
- Documentation of the decision to de-escalate care in situations of poor prognosis is also a mark of a high-risk visit.
The assessment of risk of the presenting problem or problems is based on the risk related to the disease process anticipated between the present encounter and the next one.
The assessment of risk for selecting diagnostic procedures and management options is based on the risk during and immediately following any procedures or treatment.” Source: https://www.aafp.org/fpm/2014/1100/p12.html
Time-based Coding
You can code 99215 based on time if you spend > 20 minutes of a 40-minute visit counseling and coordinating care. You need to document well, see the article below for what works.
99215 Examples in the clinic
See this link
https://www.aafp.org/fpm/2014/1100/p12.html