By Becky Priest, Coding Manager
Effective February 1, 2017 coders will begin using the following:
- For new patients, 8 organ systems is STILL a comprehensive exam.
- Established patients: This will be VERY important on your established level 4’s (Office/ED settings) and subsequent level 3’s (Inpatient/OBS setting).
- Instead of needing 2-7 body areas/organ systems, you will now need to document 6-7 BODY AREAS/ORGAN SYSTEMS (Expanded documentation of the areas and/or systems examined; requires more than checklists; it needs to have normal/abnormal findings documented upon
- For an expanded problem focused exam the requirement now is 2-5 BODY AREAS/ORGAN SYSTEMS (Minimal detail for areas and/or systems examined: check list type documentation without any expansion of findings)
To summarize: The new exam scoring change and the E&M codes it affects, please refer to the table below:
|Type of Exam||OLD SCORING||NEW SCORING||A MUST for the following E/M levels:|
|EXPANDED PROBLEM FOCUSED||2-7 BODY AREAS/ORG SYSTEMS (minimal detail)
|2-5 BODY AREAS/ORGAN SYSTEMS||Office established Patient 99213
Office New Patient 99202 & 99203
Hospital subsequent patient 99232 (Inpatient), 99225 (Obs)
|DETAILED||2-7 BODY AREAS/ORG SYSTEMS (minimal detail)||6-7 BODY AREAS/ORGAN SYSTEMS||Office Established Patient 99214
Office New Patient 99203
ED Patient 99284
Hospital subsequent patient 99233 (Inpatient), 99226 (Obs)
|COMPREHENSIVE||8 ORGAN SYSTEMS||NO CHANGE-STILL 8 ORGAN SYSTEMS||Office Established Patient 99215
Office New Patient 99204
ED Patient 99285
New Hospital patient 99222, 99223 (Inpatient), 99219 and 99220 (Obs)
If you would like more information please feel free to reach out to us.
If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfirst.com