Level 5 New Patient Office Visit (99205)

This is the big daddy. The 99205 represents the highest level of care for new patients seen in the office.  This is the third most popular code used to bill for these encounters among internist who select the 99205 level of care for only 21% of new office patients.  The reimbursement for this level of care is approximately $197, which is pretty good.  Usually the problems are of moderate to high severity. You are most likely not using this level of care enough (i.e., you are probably under-coding--take the web-course below to see why).

The documentation for this encounter requires THREE out of THREE of the following :

1)  Comprehensive History
2)  Comprehensive Exam
3)  High Complexity Medical Decision-Making

Or 60 minutes spent face-to-face with the patient if coding based on time.The appropriate documentation must be included.

Clinical Example

This topic is covered in more detail in of one of our web-based E/M coding courses.
New Office Patients
		Related Topics
		Level 1 New Office Visits Level 2 New Office Visits Level 3 New Office Visits Level 4 New Office Visits
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Now that the consult codes have been eliminated for Medicare patients, the new office patient visit has become the most common outpatient initial encounter. Learn exactly what needs to be documented for each level of care for these visits. All levels of care are discussed.		The Complete E/M Coding Curriculum The Outpatient Curriculm The Coder Curriculum
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