If a new patient is seen in the office but for whatever reason there is no examination performed, there is just a comprehensive history and moderate decision making, and there is no reference to time or counseling/coordination of care, do you report code 99499 or can you report and use the established patient codes 99212 - 99215 (REVISED IN 2013) which only require two of three, vs. new codes that require three of three? ...
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Article Overview
This article discusses office and other outpatient evaluation and management coding for a new patient encounter when the documentation does not include all required components. It is relevant to coders, billers, and clinical documentation staff who work with evaluation and management rules, component requirements, and reduced-services reporting guidance. The article provides general guidance on how the scenario is framed and references the outpatient code families and a modifier discussed in that context.
Why This Topic Matters
Correctly recognizing whether an office/outpatient new-patient visit meets the expected documentation pattern affects claim reporting and compliance. This topic matters because it involves common E/M coding decisions, including when reduced-services reporting is considered.
What You Will Learn
- How the article frames a new-patient office/outpatient E/M documentation scenario
- Which outpatient E/M code families are referenced in the discussion
- How reduced-services reporting is addressed at a high level
- What general documentation elements are discussed in relation to encounter level selection
Who Should Read This
- Medical coders
- Billing staff
- Compliance personnel
- Clinical documentation improvement staff
- Physician office staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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