To the Editor:

While reading “How to Get All the 99214s You Deserve” [October 2001, page 43], and the accompanying editorial [page 15], I was dismayed to learn that only 16 percent of established visits to family physicians are coded 99214.

My experience is that most physicians believe a normal visit starts at 99213 and that something special must be done to get to 99214. The majority of visits to family physicians involve either working up new health problems or following up multiple medical problems. I don’t know how we can adequately provide these services without doing all that is necessary to code a 99214. Certainly the majority of these visits must include covering at least seven historical facts and two organ systems (one in detail) and prescribing medication or ordering further tests – otherwise known as 99214.

The Direct Observation of Primary Care Study [ J Fam Pract. 1998; 46:377–389] documented an average visit length of 10 minutes. Although the study didn’t measure levels of service, one can conclude that a 99214 could easily be delivered in that time. It seems to me that continuous, comprehensive care is best delivered via a series of 99214s.