Article Date: 5/1/2013

Coding Strategies
coding strategy

The 992XX Codes for E & M

Treating medical eye patients goes beyond the 920XX codes.

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JOHN RUMPAKIS, O.D., M.B.A.

The 992XX Evaluation & Management (E & M) codes consist of 10 different codes: 99201 to 99205 for New patients and 99211 to 99215 for Established patients. Some of the most commonly used 992XX codes:

• 99201

o A problem-focused history
o A problem-focused examination
o Straightforward medical decision-making

• 99202

o An expanded problem-focused history
o An expanded problem-focused examination
o Medical decision-making of low complexity

• 99203

o A detailed history
o A detailed examination
o Medical decision-making of moderate complexity

• 99212

o A problem-focused history
o A problem-focused examination
o Straightforward medical decision-making

• 99213

o An expanded problem-focused history
o An expanded problem-focused examination
o Medical decision-making of low complexity

• 99214

o A detailed history
o A detailed examination
o Medical decision-making of moderate complexity

Here are the basic rules to follow, at minimum, with regard to the E & M codes.

1. Correctly defined patient

A patient is considered “established” only if he/she has been seen by you or another doctor in your specialty group within the last three years. Otherwise, the patient is considered “new.”

2. Additional diagnosis

If the patient presents for a follow-up visit post the initial diagnosis and prescribed treatment exam, and he/she does not present with a new problem or a complication of an existing condition at the follow-up visit, codes 99212, 99213 and 99214 are the most common.

Why isn’t 99211 listed? This code is typically reserved for a visit that does not require the presence of you, the doctor, or another qualified healthcare professional. An example: a patient seen by one of your technicians.

3. The primary components

The practical reality is that, the majority of the time, the history, examination and medical decision-making determine the level of visit.

Remember: In an established patient, only two of the three key components must meet or exceed the stated requirement to qualify for a particular E & M code.

Facilitating the process

If your practice does not employ an EHR that determines the E & M code based on what is entered into it, I recommend a “cheat sheet” that breaks down the components of what comprises the history, exam and medical decision-making levels. A caveat: EHR “autocoding” programs are not always correct, particularly in the area of medical decision-making. So, you, as an individual, must know the coding rules.

E & M codes play an important part in a medical eyecare practice. Learn them well, use the appropriate code level, and your patient and your practice will be rewarded. OM

DR. RUMPAKIS IS PRESIDENT AND CEO OF PRACTICE RESOURCE MANAGEMENT, INC., A CONSULTING, APPRAISAL AND MANAGEMENT FIRM FOR HEALTHCARE PROFESSIONALS. HE’S DEVELOPED AN INTERNET-BASED CPT CODE SOFTWARE PROGRAM AND IS A PROLIFIC LECTURER ON THESE TOPICS. SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.



Optometric Management, Volume: 48 , Issue: May 2013, page(s): 76