procedure Code 99202 OFFICE OUTPATIENT NEW 20 MINUTES
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 providers 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. Physicians typically spend 20 minutes face-to-face with the patient and/or family.
99202 Expanded Problem Focused 20 MIn
procedure Code Descriptor Work RVU RVU RVU RVU Total RVU Total RVU
99202 Office Visit, New Pt 0.88 0.80 0.31 0.05 1.73 1.24
Can medical doctor bill Procedure code 99202 & 94150
Ans : Yes.
Note : Evaluation and Management Procedure -4 code 99202 (office visit, new patient, level 2) may be billed by a respiratory care practitioner once every three years; however, the recipient must not have been seen for any reason during the preceding three-year period by the same respiratory care practitioner. Procedure -4 code 99212 (office visit, established patient, level 2) may be billed by a respiratory care practitioner once in six months by the same provider, for the same recipient, with authorization.
Can we bill Procedure 99202 and 99381 on Same day.
No, we cant because both are E & M code and one code only eligible to pay.
Evaluation and Management Codes
In a health department environment, a limited range of E & M codes would be submitted including 99201, 99202, 99203, 99211, 99212 and 99213. These codes are used for new patients (99201, 99202, 99203) and established patients (99211, 99212, 99213) when treated in an office and/or outpatient setting.
There also are preventive medicine codes that may be used to report the preventive medical evaluation of infants, children and adults. These visits will not have a presenting problem as they are “well” preventive visits. These codes are defined as a new or established patient and by age. Health Care Reform Preventive Health Benefits with Recommended Procedure and Diagnosis Codes The codes for new patients are 99381-99387 and for established patients 99391- 99397. If the age of the patient does not match the age described in the code, the claim will be rejected.
According to AMA Procedure and BCBSKS definitions, a new patient is a patient who hasn’t been seen for three or more years in a practice. An established patient is a patient who has been treated in the practice within the past three years.
When a patient makes an appointment, a reason for the encounter needs to be established. Per AMA Procedure , a “concise statement describing the symptom, problem, condition, diagnosis or other factor that is the reason for the encounter, usually stated in the patient’s words.”
At this point a diagnosis is established for the encounter. The reason for the encounter will be assigned an ICD-9 code to correlate with the AMA Procedure code.
An ICD-9 code defines what prompted the encounter and the AMA Procedure ® code defines what service was performed during the encounter.
The different levels of office visits are determined by six of seven components:
• Medical decision making
• Coordination of care
• Nature of presenting problem
• Time *
*In a health department setting, time probably would not be a factor in determining the level of E & M code.
However, the first three components – history, examination, medical decision making – are key components to selecting the level of E & M code. The extent of the history is determined by the clinical opinion of the performing provider based on the patient’s complaints. The levels of history most likely to be seen in a health department setting are problem and expanded problem focused.
Per AMA Procedure guidelines they are defined as follows:
• Problem focused: chief complaint; brief history of present illness or problem.
• Expanded problem focused: chief complaint; brief history of present illness; problem pertinent system review.
• Detailed: chief complaint; extended history of present illness; problem pertinent system review extended to include a review of a limited number of additional systems; pertinent past, family, and/or social history directly related to the patient’s problems.
The next step is to decide on the appropriate examination level. Once again, this is determined by the performing provider. The level of examinations which would be expected to be seen in a health department setting is as follows per Procedure guidelines:
• Problem focused: a limited examination of the affected body area or organ system.
• Expanded problem focused: a limited examination of the affected body area or organ system and other symptomatic or related organ system(s).
• Detailed: an extended examination of the affected body area(s) and other symptomatic or related organ system(s).
The third key component is to determine the complexity of the medical decision making as determined by the performing provider. In a health department setting the two levels of medical decision making that would routinely be seen are straightforward and low complexity.
• Straightforward: minimal number of diagnoses or management options; minimal or no amount and/or complexity of data to be reviewed; minimal risk of complications and/or morbidity or mortality would be involved.
• Low complexity: limited number of diagnoses or management options; limited amount and/or complexity of data to be reviewed; low risk of complications and/or morbidity or mortality would be involved.
After selecting the level of office visit that is to be submitted for reimbursement, it needs to be determined what additional services, if any, were provided to the patient, i.e., injections and or immunizations.
The CMS HCPCS code list would be used to locate drugs to supplement the AMA Procedure ®codes as the second level of the coding system. After selecting the level of office visit to be submitted, and if applicable, a second level (HCPCS) code; a diagnosis code must be assigned. Per AMA Procedure guidelines, the primary diagnosis is what prompted the encounter as described in the patient’s own words.
Per the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) guidelines, the primary diagnosis is what prompted the encounter as described in the patient’s own words.
Review of Systems:
These are based on questions that the provider asks the patient.
At least one item must come from a specific area for that area to be included. If patient’s condition prevents them from doing a review of system (a physical or mental condition), it should be stated so and then Review of Systems will receive the necessary credit.
This generally starts with “Patient denies…” or “Patient states….”
1. Constitution – general opinion of health
3. Ears, Nose, Throat, Mouth
9. Integumentary (and/or Breasts)
Statements such as “ROS done” or All ROS negative” are inappropriate.
Level 99202, 99212 requires none
Level 99203, 99213 requires at least 1
Level 99204, 99214 requires at least 2
Level 99205, 99215 requires at least 10