Evaluation and Management CPT CODE LIST

COMMON SETS OF CODES USED TO BILL FOR E/M SERVICES

When billing for a patient’s visit, select codes that best represent the services furnished during the visit. A billing specialist or alternate source may review the provider’s documented services before submitting the claim to a payer. These reviewers may help select codes that best reflect the provider’s furnished services. However, the provider must ensure that the submitted claim accurately reflects the services provided.

The provider must ensure that medical record documentation supports the level of service reported to a payer. You should not use the volume of documentation to
determine which specific level of service to bill.


Services must meet specific medical necessity requirements in the statute, regulations, and manuals and specific medical necessity criteria defined by National Coverage Determinations and Local Coverage Determinations (if any exist for the service reported on the claim). For every service billed, you must indicate the specific sign, symptom, or patient complaint that makes the service reasonable and necessary

Evaluation and Management      - CPT CODE LIST

Section     Code Range     Subsection     CodeCount    

               First     Last     
CPT     99201     99215     Office or Other Outpatient Services     10     

CPT     99217     99220     Hospital Observation Services     4     

CPT     99221     99239     Hospital Inpatient Services     11    

CPT     99241     99275     Consultations     18    

CPT     99281     99288     Emergency Department Services     6     

CPT     99289     99290     Patient Transport     2     

CPT     99291     99292     Critical Care Services     2     

 CPT    99295     99298     Neonatal Intensive Care     4   

 CPT    99301     99316     Nursing Facility Services     8    

 CPT    99321     99333     Domiciliary, Rest Home, Custodial Care Services     6    

 CPT    99341     99350     Home Services     9   

 CPT    99354     99360     Prolonged Services     7   

 CPT    99361     99373     Case Management Services     5    

 CPT    99374     99380     Care Plan Oversight Services     6    

 CPT    99381     99429     Preventive Medicine Services     22   

 CPT    99431     99440     Newborn Care     6   

 CPT    99450     99456     Special Evaluation and Management Services     3    

 CPT    99499     99499     Other Evaluation and Management Services     1   

E & M code CPT modifiers


SELECTING THE CODE THAT BEST REPRESENTS THE SERVICE FURNISHED

Billing Medicare for an E/M service requires the selection of a Current Procedural Terminology (CPT) code that best represents:

™ Patient type;
™ Setting of service; and
™ Level of E/M service performed.

PATIENT TYPE

For purposes of billing for E/M services, patients are identified as either new or  established, depending on previous encounters with the provider. A new patient is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years.

An established patient is an individual who has received professional services from the physician/NPP or another physician of the same specialty who belongs to the same group practice within the previous 3 years.

SETTING OF SERVICE

E/M services are categorized into different settings depending on where the service is furnished. Examples of settings include:

™ Office or other outpatient setting;
™ Hospital inpatient;
™ Emergency department (ED); and
™ Nursing facility (NF).

LEVEL OF E/M SERVICE PERFORMED

The code sets to bill for E/M services are organized into various categories and levels. In general, the more complex the visit, the higher the level of code you may bill within the appropriate category. To bill any code, the services furnished must meet the definition of the code. You must ensure that the codes selected reflect the services furnished. The three key components when selecting the appropriate level of E/M services provided are history, examination, and medical decision making. Visits that consist predominately of counseling and/or coordination of care are an exception to this rule. For these visits, time is the key or controlling factor to qualify for a particular level of E/M services

No comments:

Medical Billing Popular Articles