These codes are used to report E/M services for established office patients. There are five levels of care. There is significant variation in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the encounter in order to optimize reimbursement.
For these encounters, the level of care may be selected based on the MDM required for the visit OR based on time spent.
The rules for performing and documenting these encounters are covered extensively in the ESTABLISHED OFFICE PATIENTS course, which includes examples for all five levels of care as well as detailed explanations of the MDM and time required for each visit.
The 99211 level of care for established office patients (otherwise known as a level 1 established office visit) is the lowest level of care for established office visits. This level of care does not require the presence of a physician. Usually, the problems are straightforward and this encounter is performed and documented by office staff. Examples include a blood pressure check or final examination of a TB skin test.
The99211 level of care is used for about 1.9% of established office visits among internists and pays about $24.
The 99212 level of care for established office patients (otherwise known as a level 2 established office visit) is the second lowest level of care for established office visits. This level of care requires only straightforward medical decision-making or a total of ten minutes of time spent.
The 99212 level of care is used for about 2.3% of established office visits among internists and pays about $59.
The 99213 level of care for established office patients (otherwise known as a level 3 established office visit) is the third highest level of care for established office visits. This level of care requires low complexity medical decision-making or a total of twenty minutes of time spent.
The 99213 level of care is used for about 31% of established office visits among internists and pays about $95.
The 99214 level of care for established office patients (otherwise known as a level 4 established office visit) is the second highest level of care for established office visits. This level of care requires moderate complexity medical decision-making or a total of thirty minutes of time spent.
The 99214 level of care is used for about 58% of established office visits among internists and pays about $137.
The 99215 level of care for established office patients (otherwise known as a level 5 established office visit) is the highest level of care for established office visits. This level of care requires high complexity medical decision-making or a total of forty minutes of time spent.
The 99215 level of care is used for about 6.4% of established office visits among internists and pays about $192.
The rules for performing and documenting established office visits are covered extensively in the ESTABLISHED OFFICE PATIENTS course, which includes examples for all five levels of care as well as detailed explanations of the MDM and time required for each visit.