99204—Office or other outpatient visit for the E/M of a new patient, which requires these three key components:
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of moderate complexity.
99205—Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components:
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of moderate complexity.
The rheumatologist sees a patient for a follow-up to a visit six weeks ago. She takes a detailed history, conducts an expanded problem-focused examination, and the medical decision making was of moderate complexity. Because only two of the three key components are needed, the examination is not considered when determining the level of the visit. This established patient visit would be a level four.
99213—Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:
- An expanded problem focused history;
- An expanded problem-focused examination; and
- Medical decision making of moderate complexity.
99214— Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:
- A detailed history;
- A detailed examination; and
- Medical decision making of moderate complexity.
The key to compliance is coding all charges correctly. Understanding the guidelines for coding a new patient versus an established patient will cut down on incorrect billing and reduce your denials and appeals. For an in-depth look at time in determining the level of E/M visit, check out “The Dos and Don’ts of Verifying Insurance Benefits” on page 15 of the January 2012 issue of The Rheumatologist.
If you have any questions concerning coding and billing documentation, contact Melesia Tillman, CPC-I, CRCH, CHA, at (404) 633-3777 ext. 820, or [email protected].
Melesia Tillman, CPC-I, CRHC, CHA, is the coding specialist for the ACR.
