Level 5 Visits 125 Level 5 Visits Level 5 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 explore example scenarios that might be reported with codes at level 5 of the office E/M services (99205 and 99215) for dates of service on and after January 1, 2021. ★▲99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically history and/or examination and high level of ­appropriate medical decision making. When using time for code selection, 60–74 minutes of total time is spent on the date of the encounter. (For services 75 minutes or longer, see Prolonged Services 99417) ★▲99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40–54 minutes of total time is spent on the date of the encounter. (For services 55 minutes or longer, see Prolonged Services 99417) 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 5 codes selected based on MDM, 2 of 3 elements must be met or exceeded to support a high level of MDM. Table 1 shows the elements of MDM to support high-complexity MDM. When selecting a code based on the physician’s or other qualified health care professional’s (QHP’s) total time spent directed to care of the indi- vidual patient, on the date of the encounter, 60 to 74 minutes is required to report 99205 and 40 to 54 minutes to support 99215. Total time includes face-to-face and non–face-to-face time (eg, time spent entering information into the medical record) directed to the care of the individual patient on the date of a visit. Ped Office-based EM Coding booklet interior.indd 125 Ped Office-based EM Coding booklet interior.indd 125 9/14/20 12:02 PM 9/14/20 12:02 PM
Previous Page Next Page