Code -99202-99499
Evaluation and Management
In Evaluation and ManagementÂ
First we identify the Place of Service
- Office Visit
- Hospital Inpatient and Observation Care Services
- Consultations
- Emergency Department Services
- Nursing Facility Services
- Home or Residence Services
- Prolonged Services With or Without Direct Patient Contact on the date of an evaluation and Management services
Patient Type
- New PatientÂ
- Established Patient
New Patient : A new patient is one who has not received any professional services from the physician or other qualified healthcare professional of the same group practice within the past three years.
Established Patient : A established patient is one who has received any professional services from the physician or other qualified healthcare professional of the same group practice within the past three years
Level of E/M
MDM Level : Medical Decision Making
MDM includes establishing diagnoses, assessing the status of a condition, and/or selecting a management option. MDM by three elements
- Test
- Independent interpretations of testsÂ
- Discussion of management or test interpretation with the external physicianÂ
Level Of MDM
- Straightforward
- Low
- Moderate
- High
Â
Straightforward :Â
Number and Complexity of problems at the Encounter
One minor problem
Amount and complexity of data to be reviewed
Minimal or none
Risk of Complications and Morbidity or Mortality of patient ManagementÂ
Minimal risk of morbidity from additional diagnostic test or treatmentÂ
Low
Number and Complexity of problems at the Encounter
2 or more minor problem
Amount and complexity of data to be reviewed
Limited
Category 1: Test and documents
Any combination of 2 from the followingÂ
- Review of prior external notes for each unique source
- Review of the results of each unique test
- Ordering of each unique test
OR
Category 2: Assessment requiring an independent historians
Â
Risk of Complications and Morbidity or Mortality of patient ManagementÂ
Low risk of morbidity from additional diagnostic test or treatmentÂ
Moderate
Number and Complexity of problems at the Encounter
- 1 or more chronic problem illnesses with exacerbation
- OR
- 2 or more stable chronic illness
- OR
- 1 undiagnosed new problem with uncertain prognosisÂ
OR
1 acute illness with systemic systems
OR
1 acute complicated injuryÂ
Amount and complexity of data to be reviewed
Category 1
Any combination of 2 from the following
- Review of prior external notes from each unique source
- Review of the results or each unique test
- Ordering of each unique test
- Assessment requiring an independent historians
Category 2
Independent interpretation of testÂ
Category 3
Discussion of management or test interpretationÂ
Risk of Complications and Morbidity or Mortality of patient ManagementÂ
- Prescription drug management
- Decision regarding minor surgery with identified patient or procedure risk factorsÂ
- Decision regarding elective major surgery without identified patient or procedure risk factorsÂ
- Diagnosed or treatment significantly limited by social determinations of healthÂ
HIGH
Number and Complexity of problems at the Encounter
- 1 or more chronic illness with severe exacerbation progression or side effects of treatment
- 1 acute or chronic illness or injury that posses a threat to life or bodily functionÂ
Risk of Complications and Morbidity or Mortality of patient ManagementÂ
- Drug therapy requiring monitoring for toxicity
- Decision regarding elective major surgery with identified patient or procedure risk factor
- Decision regarding emergency major surgery Â
- Decision regarding parenteral controlled substanceÂ
New PatientÂ
99202-99205
- 99202
- 99203
- 99204
- 99205
Established Patient
99211-99215
In 99211: That may not require the presence of a physicianÂ
- 99212: Straightforward
- 99213: Low
- 99214: Moderate
- 99215: HighÂ
New Codes in 2025
Synchronous Audio-Video Evaluation and ManagementÂ
- 98000 : StraightforwardÂ
- 98001: Low
- 98002:Â Moderate
- 98003: High
Established patient
- 98004: Straightforward
- 98005: Low
- 98006: Moderate
- 98007: HighÂ
Synchronous Audio Only Evaluation and ManagementÂ
New Patient
- 98008: Straightforward
- 98009: Low
- 98010: Moderate
- 98011: High
Established Patient
- 98012: Straightforward
- 98013: Low
- 98014: Moderate
- 98015: High
Hospital Inpatient or Observation Care
Initial Hospital inpatient or observation care
- 99221: SF/Low
- 99222: Moderate
- 99223: High
Subsequent Hospital inpatient or observation careÂ
- 99231: SF/Low
- 99232: Moderate
- 99233: High
Hospital Inpatient or Observation Care Services (Including Admission and discharge Services
- 99234
- 99235
- 99236
Office or other outpatient Consultation Codes
- 99242
- 99243
- 99244
- 99245
Inpatient or Observation Consultations
- 99252
- 99253
- 99254
- 99255
Emergency Department Codes
No distinguish New or Established patient in emergency DepartmentÂ
- 99281: There is no requirement the presence of a physician or other qualified health care professionalÂ
- 99282
- 99283
- 99284
- 99285
Critical Care Code
99291
+99292
Depend upon the timing
Home or Residence Services
New Patient
- 99341
- 99342
- 99344
- 99345
Established Patient
- 99347
- 99348
- 99349
- 99350Â
IMP: Hotel, campground, hostel or cruise ship, so we use the same code
99358: Prolonged evaluation and management service before and/or after direct patient care; first hour
+99359: Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service)
+Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
+99416: Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service)
Preventive Medicine Services
New Patient
- 99381
- 99382
- 99383
- 99384
- 99385
- 99386
- 99387
Established Patient
- 99391
- 99392
- 99393
- 99394
- 99395
- 99396
- 99397
Inpatient Neonatal and Pediatric Critical Care
- 99468: Initial inpatient neonatal critical care
- 99469: Subsequent inpatient neonatal critical care
- 99471: Initial inpatient pediatric critical care
- 99472: Subsequent inpatient pediatric critical care
- 99475: Initial inpatient pediatric critical careÂ
- 99476 : Subsequent
END
