|
|
Evaluation
and Management Coding Reference Sheet |
|
|
|
|
|
|
|
|
|
|
|
| CODE |
Office Visit Est. 2/3 |
HISTORY |
EXAM |
MDM |
Time |
| 99211 |
Office visit, No.
Phys. Required |
N/A |
N/A |
minimal |
5
min |
| 99212 |
Office visit, Est.
(Prob focused) |
Problem
Focused |
1 |
Straightforward |
10
min |
| 99213 |
Office visit, Est
(Low) |
Exp.
Problem Focused |
2-4 |
Low |
15
min |
| 99214 |
Office visit, Est.
(Mod.) |
Detailed |
5-7 |
Moderate |
25
min |
| 99215 |
Office visit Est.
(High |
Comprehensive |
8 |
High |
40
min |
| CODE |
Office Visit New 3/3 |
HISTORY |
EXAM |
MDM |
Time |
| 99201 |
IOV (No Referral) |
Problem
Focused |
1 |
Straightforward |
10
min |
| 99202 |
IOV (No Referral) |
Exp.
Problem Focused |
2-4 |
Straightforward |
20
min |
| 99203 |
IOV (No Referral) |
Detailed |
5-7 |
Low |
30
min |
| 99204 |
IOV (No Referral) |
Comprehensive |
8+ |
Moderate |
45
min |
| 99205 |
IOV (No Referral) |
Comprehensive |
8+ |
High |
60
min |
| |
Office Consults 3/3 |
HISTORY |
EXAM |
MDM |
Time |
| 99241 |
Office Consult
minimal |
Problem
Focused |
1 |
Straightforward |
15 |
| 99242 |
Office Consult Prob.
Focused |
Exp.
Problem Focused |
2-4 |
Straightforward |
30 |
| 99243 |
Office Consult (Low) |
Detailed |
5-7 |
Low |
40 |
| 99244 |
Office Consult (Mod.) |
Comprehensive |
8+ |
Moderate |
60 |
| 99245 |
Office Consult (High) |
Comprehensive |
8+ |
High |
80 |
| |
Prolonged Services |
|
|
|
Time |
| 99354 |
Office Prolonged
Service |
add
on to base code |
|
|
60 |
| 99355 |
Each Additional 30 minutes |
1
unit each 30 min |
|
|
30 |
| -24 |
Modifier 24 |
Add on to E/M when the E/M is unrelated during
a Postoperative Global Period, 2nd Dx |
|
| -25 |
Modifier 25 |
Significant, Separately identifiable E/M
service on the same day of a procedure |
|
| -57 |
Modifier 57 |
E/M pre-op, but before the Decision for Surgery |
|
| |
Hospital Admission
3/3 |
HISTORY |
EXAM |
MDM |
Time |
| 99221 |
Initial Admission,
Low |
Detailed |
5-7 |
Straightforward |
30 |
| 99222 |
Initial Asmission,
Moderate |
Comprehensive |
8+ |
Moderate |
50 |
| 99223 |
Initial Admission,
High |
Comprehensive |
8+ |
High |
70 |
| |
Hospital Follow up 2/3 |
HISTORY |
EXAM |
MDM |
Time |
| 99231 |
Inpt Follow
Straightforward |
Prob.
Focused Interval |
1 |
Low/
Stable, Recovering, Improving |
15
min bedside, floor or unit |
| 99232 |
Inpt Follow Moderate |
Exp
Prob Foc. Interval |
2-4 |
Moderate Inadequate response/Minor
Complication |
25
min bedside, floor or unit |
| 99233 |
Inpt Follow High |
Detailed
Interval |
5-7 |
High.
Unstable, significant complication
significant new problem |
35
min bedside and floor or unit |
| 99238 |
Discharge under 30
minutes |
|
|
|
|
| 99239 |
Discharge over 30
minutes |
Be sure to dictate time spent in your discharge
summary |
|
|
|
|
|
|
|
|
|
|
|
Evaluation
and Management Coding Reference Sheet |
|
|
|
|
|
|
|
|
| |
Observation Codes 3/3 |
HISTORY |
EXAM |
MDM |
Time |
| 99217 |
Observation care
discharge |
|
|
|
|
| 99218 |
Initial Observation
Low |
Detailed |
5-7 |
Low |
|
| 99219 |
Initial Observation
Moderate |
Comprehensive |
8+ |
Moderate |
|
| 99220 |
Initial Observation
High |
Comprehensive |
8+ |
High |
|
| 99234 |
Admit/Discharge same
day Low |
Detailed |
5-7 |
Low |
|
| 99235 |
Admit/Discharge same
day Mod |
Comprehensive |
8+ |
Moderate |
|
| 99236 |
Admit/Discharge same
day High |
Comprehensive |
8+ |
High |
|
| |
Inpatient
Consultation 3/3 |
Rule
of R's |
Only one per hospitalization |
| 99251 |
Initial inpt consult
straightforward |
Prob.
Focused |
1 |
Straightforward |
20
min |
| 99252 |
Initial inpt consult
Expanded |
Exp.
Problem Focused |
2-4 |
Straightforward |
40
min |
| 99253 |
Initial inpt consult
Detailed |
Detailed |
5-7 |
Low |
55
min |
| 99254 |
Initial inpt consult
Moderate |
Comprehensive |
8+ |
Moderate |
80
min |
| 99255 |
Initial inpt consult
High |
Comprehensive |
8+ |
High |
110
min |
| |
Follow up inpt
consults 3/3 |
Use In-pt follow up unless the initial
consultation was completed and a subsequent consult is requested |
| 99261 |
Follow up inpt
consult low |
Prob.
Focused |
1 |
Low |
10 |
| 99262 |
Follow up inpt
consult Mod |
Exp
Prob Focused |
2-4 |
Moderate |
20 |
| 99263 |
Follow up inpt
consult High |
Detailed |
5-7 |
High |
30 |
| |
Prolonged Services
Inpatient (with patient contact) |
|
|
|
Time |
| 99356 |
Inpt. Prolonged Phys.
Service |
add
on to base code |
|
|
60 |
| 99357 |
Each Additional 30 minutes |
1
unit each 30 min |
|
|
30 |
| |
Prolonged Services Inpatient (without patient contact) |
|
|
|
Time |
| 99358 |
Inpt. Prolonged Phys.
Service |
add
on to base code |
|
|
60 |
| 99359 |
Each Additional 30 minutes |
1
unit each 30 min |
|
|
30 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Time
component is considered only when greater than 50% of the visit is spent is
counseling and coordination of care.
Summarize the content and nature of the discussion and the necessity
for the time spent. Document the clock time. |
|
|
|
|
|
|
|
No PFSH is required:
99231-33, 99261-63 and 99311-33 |
|
|
|
|
|
|