Evaluation and
Management (E&M) codes are to be performed by physicians, nurse
practitioners and physician assistants. Physician codes should be billed using
the rendering provider’s individual NPI.
99201 Office or other outpatient visit for the evaluation and management of a
new patient, which requires these three key components: a problem focused
history; a problem focused examination; and straightforward medical decision
making. Counseling and/or coordination of care with other physicians, other
qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient's and/or family's needs. Usually,
the presenting problem(s)
are self limited or minor. Typically, 10 minutes are spent face-to-face with
the patient and/or family.
Billing Instructions: Bill 1 unit per visit.
99202 Office or other outpatient visit for the evaluation and management of a
new patient, which requires these three key components: an expanded problem
focused history; an expanded problem focused examination; and straightforward
medical decision making. Counseling and/or coordination of care with other
physicians, other qualified health care professionals, or agencies are provided
consistent with the nature of the problem(s) and the patient's and/or family's
needs. Usually, the presenting problem(s) are of low to moderate severity.
Typically, 20 minutes are spent face-to-face with the patient and/or family.
Billing Instructions: Bill 1 unit per visit.
99203 Office or other outpatient visit for the evaluation and management of a
new patient, which requires these three key components: a detailed history; a
detailed examination; and medical decision making of low complexity. Counseling
and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting
problem(s) are of moderate severity.
Typically, 30 minutes are spent face-to-face with the patient and/or family.
Billing Instructions: Bill 1 unit per visit.
99204 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. Counseling and/or coordination of care with other physicians, other
qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient's and/or family's needs. Usually,
the presenting problem(s) are of moderate to high severity. Typically, 45
minutes are spent face-to-face with the patient and/or family.
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 high
complexity. Counseling and/or coordination of care with other physicians, other
qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient's and/or family's needs. Usually,
the presenting problem(s) are of moderate to high severity. Typically, 60
minutes are spent face-to-face with the patient and/or family. Billing
Instructions: Bill 1 unit per visit.
99211 Office or other outpatient visit for the evaluation and management of an
established patient, that may not require the presence of a physician or other
qualified health care professional. Usually, the presenting problem(s) are
minimal. Typically, 5 minutes are spent performing or supervising these
services.
Billing Instructions: Bill 1 unit per visit.
99212 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 problem focused history; a problem focused examination; straightforward
medical decision making. Counseling and/or coordination of care with other
physicians, other qualified health care professionals, or agencies are provided
consistent with the nature of the problem(s) and the patient's and/or family's
needs. Usually, the presenting Problem(s) are self limited or minor. Typically,
10 minutes are spent face-to-face with the patient and/or family.
Billing Instructions: Bill 1 unit per visit.
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;
medical decision making of low complexity. Counseling and/or coordination of
care with other physicians, other qualified health care professionals, or
agencies are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs. Usually, the presenting problem(s) are of low
to moderate severity. Typically, 15 minutes are spent face-to-face with the
patient and/or family. Billing Instructions: Bill 1 unit per visit.
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; medical decision making of moderate
complexity. Counseling and/or coordination of care with other physicians, other
qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient's and/or family's needs. Usually,
the presenting problem(s) are of moderate to high severity. Typically, 25
minutes are spent face-to-face with the patient and/or family.
Billing Instructions: Bill 1 unit per visit.
99215
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 comprehensive history; a comprehensive examination; medical decision making
of high complexity. Counseling and/or coordination of care with other
physicians, other qualified health care professionals, or agencies are provided
consistent with the nature of the problem(s) and the patient's and/or family's
needs. Usually, the presenting problem(s) are of moderate to high severity.
Typically, 40 minutes are spent face-toface with the patient and/or family.
Billing Instructions: Bill 1 unit per visit.
99217
Observation care discharge day management. Billing Instructions: This code is
to be utilized to report all services provided to a patient on discharge from
“observation status” if the discharge is on other than the initial date of
“observation status.” To report services to a patient designated as
“observation status” or “inpatient status” and discharged on the same date, us
the codes for Observation or Inpatient Care Services [including Admission and Discharge
Services, 99234-99236 as appropriate.]
99218 Initial observation care, per day, for the evaluation and management of a
patient which requires these three key components: a detailed or comprehensive
history; a detailed or comprehensive examination; and medical decision making
that is straightforward or of low complexity. Counseling and/or coordination of
care with other physicians, other qualified health care professionals, or
agencies are provided consistent with the nature of the problem(s) and the
patient’s and/or family’s needs. Usually, the problems(s) requiring admission
to “observation status” are of low severity. Typically, 30 minutes are spent at
the bedside and on the patient’s hospital floor or unit.
99219
initial observation care, per day, for the evaluation and management of a
patient which requires these three key components: a comprehensive history; a
comprehensive examination; and medical decision making of moderate complexity.
Counseling and/or coordination of care with other physicians, other qualified
health care professionals, or agencies are provided consistent with the nature
of the problem(s) and the patient’s and/or family’s needs. Usually, the
problems(s) requiring
admission to “observation status” are of moderate severity. Typically, 50
minutes are spent at the bedside and on the patient’s hospital floor or unit.
99220
Initial observation care, per day, for the evaluation and management of a
patient, which requires these three components: a comprehensive history; a
comprehensive examination; and medical decision making of high complexity.
Counseling and/or coordination of care with other physicians, other qualified
health care professionals, or agencies are provided consistent with the nature
of the problems(s) and the patient’s and/or family’s needs. Usually the
problem(s) requiring admission to “observation status” are of high severity.
Typically, 70 minutes are spent at the bedside and on the patient’s hospital
floor or unit.
90833 Psychotherapy, 30 minutes with patient and/or family member when
performed with an evaluation and management service (Use only as an add-on to
the appropriate CPT code.)
90836 Psychotherapy, 45 minutes with patient and/or family member when
performed with an evaluation and management service (Use only as an add-on to
the appropriate CPT code.)
90838 Psychotherapy, 60 minutes with patient and/or family member when
performed with an evaluation and management service (Use only as an add-on to
the appropriate CPT code.)
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