Level 4 Visits 119 Level 4 Visits Level 4 Visits This article provides information and examples of the changes that will be implemented for office and other outpatient evaluation and manage- ment (E/M) codes for services provided on or after January 1, 2021. In this article, we provide example scenarios that might be reported with codes at level 4 of the office E/M services (99204 and 99214) for dates of service on and after January 1, 2021. ★▲99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45–59 minutes of total time is spent on the date of the encounter. ★▲99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and ­ moderate level of medical decision making. When using time for code selection, 30–39 minutes of total time is spent on the date of the encounter. As previously noted, for each level of office E/M service, the medical decision-making (MDM) is the same for new or established patients. For level 4 codes selected based on MDM, moderate-complexity MDM is required. The Table shows the elements of MDM that support moderate-­ complexity MDM. Two of 3 elements must be met or exceeded to support a level of MDM. New Versus Established Current Procedural Terminology (CPT®) defines a new patient as one who has not received a face-to-face professional service from the same physician or other qualified health care professional (QHP) or from another physician or QHP in the same group practice and of the same exact specialty in the past 3 years. Payers may use automated claims processing to determine if a claim for a face-to- face professional service has been submitted by physicians with the same tax identification number and specialty in the past 3 years. Ped Office-based EM Coding booklet interior.indd 119 Ped Office-based EM Coding booklet interior.indd 119 9/14/20 12:02 PM 9/14/20 12:02 PM
Previous Page Next Page