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Level 4 New Patient Office Visit (99204)

This is the most popular code used to bill for new patients being seen in the office.  Internists selected the 99204 code for 48.12% of these encounters in 2015.  The 2017 Medicare allowable reimbursement for this level of care is $166.16 and it is worth 2.43 work RVUs.  Usually the presenting problems are of moderate to high severity. 

The documentation for this encounter requires THREE out of THREE of the following :
1)  Comprehensive History
2)  Comprehensive Exam
3)  Moderate Complexity Medical Decision-Making

Or 45 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 our web-based E/M coding courses.

New Office Patients

New Office Patients
  Related Topics


Basic Course Preview
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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.  
  For mutliple users, consider an E/M Compliance Web Portal.


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