14. With well visits you only need to know if the
patient is “new” or “established. New patients –
one not seen by you or the practice in 3 years
15. Well visits
Age CPT Code New CPT Code Established
Under 1 year 99381 99391
1 – 4 years 99382 99392
5 – 11 years 99383 99393
12 – 17 years 99384 99394
18 – 39 years 99385 99395
17. E&M codes are for sick visits. They are
based on the severity of the illness and
work done.
18. Note: If more than 50% of visit is
counseling, then time is an
element
19. New patient
codes require
all 3 elements
New Patients
Patients only
Established require 2 out
of 3 elements
Doesn’t
require the
presence of a 99211
physician
20. 99212
Expanded problem focused history
Expanded problem focused exam
Straightforward medical decision making
27. If you increase from 5% 99214 to 20% ,
you can increase your net income by
$20,000 without doing any more work
28. You don’t want to over code because
Medicaid and private health insurers can
and will audit you. If the documentation
doesn’t equal the code billed, they will
penalize you
29. Evaluation requested by an appropriate professional
with a report back to that person
99243 - Consult 99213 – E/M
3.17 x 36.79 1.39 x 36.79
$116.62 $51.14