So, how many E&M codes are there? How many do I have to sort through mentally? There are thousands of E&M codes. Fortunately, the following codes will be used for 99.99% of office visits:
Routine visits, new patient:
99201 – new patient, nurse visit only
99202 – new patient extremely limited history and exam. Rarely used.
92203 – new patient
99204 – new patient, detailed history and exam, moderate complexity decision-making.
99205 – new patient, comprehensive history and exam, high complexity. Almost never used.
Routine visits, established patients:
99211 – established patient, nurse visit only
99212 – established patient, very limited history and exam. Should very rarely be used.
99213 – established patient
99214 – established patient, detailed history or exam, moderate complexity decision-making.
99215 – established patient, comprehensive history or exam, high complexity decision making. Rarely used.
The process for wellness exams is much simpler. It is simply based on their age. It is assumed that you did all screenings (developmental, labwork, etc.) indicated for that individual. “Screening” in this case does not mean brief or perfunctory. A wellness exam is expected to be comprehensive and thorough.
Wellness visit, new patient:
99381 – New patient, well child, under 1y/o
99382 – New patient, well child, 1-4 y/o
99383 – New patient, well child, 5-11 y/o
99384 – New patient, well child, 12-18 y/o
99385 – New patient, well adult screening, 18-39 y/o
99386 – New patient, well adult screening, 40-64 y/o
99387 – New patient, well adult screening, 65+ y/o
Wellness visit, established patient:
99391 – Established patient, well child, under 1y/o
99392 – Established patient, well child, 1-4 y/o
99393 – Established patient, well child, 5-11 y/o
99394 – Established patient, well child, 12-18 y/o
99395 – Established patient, well adult screening, 18-39 y/o
99396 – Established patient, well adult screening, 40-64 y/o
99397 – Established patient, well adult screening, 65+ y/o
For surgeries or other procedures not listed above, you will simply need to look up the code in the CPT book. Procedures vary in complexity, and he CPT reflects that. It is out of the scope of this discussion to review every CPT code. Every specialty, including yours, most likely has certain procedures that they do most often. It is important for you to review these no your own. We will only discuss office visits here. And since coding for wellness exams is so straightforward, we need not discuss it further. That leaves us only with the discussion of office visits.
Over 95% (probably closer to 99%) of the remaining office visits will be one of the following: 99213, 99214, 99203, or 99204. That makes our lives a lot simpler.
Medical Coding and Billing For Residents 