Billing Codes

Observation (single day visit)

99221
detailed hx
detailed exam
straightforward complexity

99222
comprehensive hx
comprehensive exam
moderate complexity

99223
comprehensive hx
comprehensive exam
high complexity

Observation (Seen on different dates)
99217 - Observation care discharge (Medicaid doesn't recognize)
99218 - Detailed/Straightforward 
99219 - Comprehensive/Mod Complexity
99220 - Comprehensive/High Complexity

Follow up care
99231 - Problem focused/Straightforward
99232 - Expanded/Mod Complexity
99233 - Detailed/High Complexity

Initial visit 
99221 - Detailed/Straightforward
99222 - Comprehensive/Mod Complexity
99223 - Comprehensive/High Complexity

Initial consult
99251 - Prob. Focused/Straightforward
99252 - Expanded/Straightforward
99253 - Detailed/Low complexity
99254 - Comprehensive/Mod. Complexity
99255 - Comprehensive/High Complexity

Dialysis

90935 single HD visit
90937 repeated HD visit
90945 single PD visit
90947 repeated PD visit

Other

92950 CPR
96800 HD cannula
36620 Arterial line

I.   Hx

Problem focused
HPI 1 element
ROS none
PAST none

Expanded problem focused
HPI 1 element
ROS 1 element
PAST none

Detailed
HPI 4 elements or 3 chronic conditions
ROS 2 elements
PAST 1 element

Comprehensive
HPI 4 elements or 3 chronic conditions
ROS 10 elements
PAST 1 element from medical, family & social

II.  Exam

Problem focused 1 element
Expanded problem focused six elements
Detailed 2 elements in 6 areas
Comprehensive 2 elements from 9 areas

III.  Medical decision making

Straight forward none
Low complexity 2 dx
                  Two minor problems and on OTC drugs
Two established problems and on OTC drugs
One established problem worse and on OTC drugs
Moderate complexity 3 dx
                  Three stable problems and on prescription drugs
One new problem requiring no work-up and on 
prescription drugs
One established problem but worse and one stable 
problem and on prescription drugs
High complexity 4 dx
                  Four stable problems and IV narcotics or DNR or peritonitis 
or ARF or drug therapy requiring intensive monitoring or 
coronary angiography or SZ or TIA or weakness or sensory 
loss or multi-truama or acute MI or PE or severe resp distress 
or progressive severe rheumatoid arthritis or psychosis with 
threat to self or others or other illness/injury that poses a threat 
to life or bodily function or chronic illness with severe 
exacerbation, progression or side effect of tx

Four stable problems and review/order lab and review/order 
radiology and discuss test result with performing MD and 
obtain old records 

Four stable problems and independent visualization of image, 
tracing or specimen and discuss case with other healthcare provider

Four stable problems and independent visualization of image, 
tracing or specimen and review & summarize old record or obtain 
history from source other than pt
 
Substitute one new problem requiring work-up instead of 4 stable 
problems above

Substitute one established problem and two stable problems instead 
of 4 stable problems above

Substitute one new problem and one stable problem instead of 4 stable 
problems above

Outpatient arena:

History:  (f/u pt levels 1, 2 , 3 & new pt levels 1, 2  = 1 element; f/u pt levels 4, 5 & new pt levels 3, 4, 5 = 4 elements or status of 3 chronic conditions - context / severity / duration / associated signs & symptoms / ameliorating or aggravating factors / location / 
quality / timing)

ROS: (f/u pt levels 1, 2 & new pt level 1 = none; f/u pt level 3 & new pt level 2 = 1; f/u pt level 3 , 4 & new pt level 3 = 2; f/u pt level 5 & new pt level 4, 5 = 10)

PAST: (f/u pt level 1, 2, 3 & new pt level 1, 2 = none; f/u pt level 4 & new pt level 3 = 1 of any; f/u pt level 5 & new pt level 4, 5 = 1 from each)

EXAM: (f/u pt level 1 = 0; f/u pt level 2 & new pt level 1 = 1; f/u pt level 3 & new pt level 2 = any 6; f/u pt level 4 & new pt level 3 = any 12; f/u pt level 5 & new pt level 4, 5 = 2 in 9 areas)

Medical Decision Making: (f/u & new pt level 1, 2 = _ 1 dx; f/u & new pt level 3 = 2 dx; f/u & new pt level 4 = 3 dx; f/u & new pt level 5 = 4 dx)

John Andy
andyjcmrdn@icloud.com