Established outpatient E/M codes in Skin Disease and Care| | | | | | Need 2 out of 3 components for established visit | | | | | |
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- Key components not required; physician need not be present (only supervising)
- Minimal evaluation/management (E/M); time spent: 5 min
99212 – Problem focused visit- Problem focused history (chief complaint and 1–3 HPI elements)
- Problem focused physical exam (1–5 elements)
- Straightforward or self-limited medical decision making
- Time spent: 10 min
| | | | | | Expanded HPI with low complexity decision making will be 99213 regardless of physical exam elements | | | | | |
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- Expanded problem focused history (1–3 HPI elements, 1 ROS)
- Expanded problem focused physical exam (≥ 6 elements)
- Low complexity decision making (one new problem or one worsening problem or two stable problems)
- Time spent: 15 min
99214 – Detailed visit- Detailed history (≥ 4 HPI elements or status of 3 chronic conditions, 2–9 ROS, 1 PFSHx)
- Detailed exam (≥ 12 elements)
- Moderate to high complexity medical decision making
- Time spent: 25 min
99215 – Comprehensive visit- Comprehensive history (≥ 4 HPI elements or status 3 conditions, ≥ 10 ROS, 3 PFSHx)
- Comprehensive exam: complete single system specialty or complete multisystem exam
- High complexity medical decision making
- Time spent: 40 min
Important Points- The limiting factor for determining the level of a new office visit depends on the physical exam, since 12 elements are needed
- Most new office visits will be 99202 unless you do a thorough physical exam (12 elements)
- If you were to do just do a waist up exam, you could code 99203 if you examined the following (the number of elements for each bold term is in parenthesis):
General: Pleasant, WDWN, alert/oriented female in no distress (3 elements)
Face, neck, chest, back, abdomen, LUE, RUE, eyes, oral mucosa (9 elements)
| | | | | | | Table 10-3 Established Outpatient E/M Codes | | | Key Components
(Need 2 of 3) | | | 99212 | | | 99213 | | | 99214 | | | 99215 | | | History | | | Problem focused
(1–3 HPI elements) | | | Expanded
(1–3 elements, 1 ROS) | | | Detailed (≥4 elements, 10 2–9 ROS, 1 PFSHx) | | | Comprehensive
(≥4 elements, 10 ROS, 3 PFSHx) | | | Physical exam | | | Problem focused
(1–5 elements) | | | Expanded
(6–11 elements) | | | Detailed
(≥12 elements) | | | Comprehensive
(≥12 elements) | | | Medical decision
making | | | Straightforward | | | Low complexity
(1 new, 2 stable,
or 1 worse) | | | Moderate to high complexity | | | High complexity | | | Time spent | | | 5 min | | | 10 min | | | 25 min | | | 40 min |
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