outpatient revenue cycle update for 2013 – cpt/hcpcs · outpatient revenue cycle update for 2013...

Outpatient Revenue Cycle Update for 2013 – CPT/HCPCS

E/M

CPT ID Description Comments 2013SI

2013APC

2013Payment

2012Payment

2012APC

2012SI

99485 N Supervision by a control physician ofinterfacility transport care of thecritically ill or critically injured pediatricpatient, 24 months of age or younger,includes two-way communication withtransport team before transport, at thereferring facility and during thetransport, including data interpretationand report; first 30 minutes

Cannot be reported on BT 131 under OPPS B

99486 N Supervision by a control physician ofinterfacility transport care of thecritically ill or critically injured pediatricpatient, 24 months of age or younger,includes two-way communication withtransport team before transport, at thereferring facility and during thetransport, including data interpretationand report; each additional 30 minutes(List separately in addition to code forprimary procedure)

Cannot be reported on BT 131 under OPPS B

10-Dec-12 of 44©2012 Health Revenue Assurance Associates, Inc. Unauthorized reproduction strictly prohibited. All rights reserved


E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99487 N Complex chronic care coordinationservices; first hour of clinical staff timedirected by a physician or otherqualified health care professional withno face-to-face visit, per calendarmonth

Patient centered management and supportservices provided by physicians, otherqualified health care professionals (QHP),and clinical staff. The services are providedto an individual residing in a home or in adomiciliary, rest home, or assisted livingfacility. And the services that address thecoordination of care by multiple disciplinesand community service agencies. Thisseries of codes are reported once percalendar month and include all non face-to-face CCCC and many be reported by thesingle physician or other QHP who assumesthe care coordination role. CMS currentlyconsidering the CCCC services as bundledservices (bundled into the services to whichthey are incident to and are not separatelypayable). Use this code to report the firsthour of clinical staff time directed by aphysician or other QHP with no face-to-facevisit.

N

99488 N Complex chronic care coordinationservices; first hour of clinical staff timedirected by a physician or otherqualified health care professional withone face-to-face visit, per calendarmonth

Use this code for the first hour of clinicalstaff time directed by a physician or otherQHP with one face-to-face visit.

N

99489 N Complex chronic care coordinationservices; each additional 30 minutes ofclinical staff time directed by aphysician or other qualified health careprofessional, per calendar month (Listseparately in addition to code forprimary procedure)

Use this code to report each additional 30minutes of clinical staff time directed by aphysician or other QHP.

N



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99495 N Transitional Care ManagementServices with the following requiredelements: Communication (directcontact, telephone, electronic) with thepatient and/or caregiver within 2business days of discharge Medicaldecision making of at least moderatecomplexity during the service periodFace-to-face visit, within 14 calendardays of discharge

The transition in care (TCM) for anestablished patient whose medical and/orpsychosocial problems that requiremoderate or high complexity medicaldecision making during transitions in care.TCM is FROM an inpatient hospital setting,partial hospital, observation status in ahospital, skilled nursing facility/nursingfacility TO the patient's community setting,such as home, domiciliary, rest home, orassisted living. CPT code 99495 requirescompletion of specific elements within 14calendar days of discharge. CMS acceptsthe use of the CPT codes for payment.

V 0605 $73.68

99496 N Transitional Care ManagementServices with the following requiredelements: Communication (directcontact, telephone, electronic) with thepatient and/or caregiver within 2business days of discharge Medicaldecision making of high complexityduring the service period Face-to-facevisit, within 7 calendar days ofdischarge

CPT code 99496 requires completion ofspecific elements within 7 calendar days ofdischarge. CMS accepts the use of the CPTcodes for payment.

V 0606 $96.96



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99201 C Office or other outpatient visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A problem focusedhistory; A problem focusedexamination; Straightforward medicaldecision making. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self limited or minor.Typically, 10 minutes are spent face-to-face with the patient and/or family.

Editorial changes to the CPT nomenclaturereporting neutrality with the addition of"qualified health care professional (QHP)".The neutrality edits replaced "provider" with"professional, and replace "practitioners"with "individuals" in the Introduction to CPTon page x of 2013 CPT Professional.

V 0604 0604 $56.77 $53.84V

99202 C Office or other outpatient visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: An expanded problemfocused history; An expanded problemfocused examination; Straightforwardmedical decision making. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low to moderateseverity. Typically, 20 minutes arespent face-to-face with the patientand/or family.


V 0605 0605 $73.68 $72.18V



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99203 C Office or other outpatient visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A detailed history; Adetailed examination; Medical decisionmaking of low complexity. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate severity.Typically, 30 minutes are spent face-to-face with the patient and/or family.


V 0606 0606 $96.96 $95.20V

99204 C Office or other outpatient visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination;Medical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 45 minutes arespent face-to-face with the patientand/or family.


V 0607 0607 $128.48 $130.53V



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99205 C Office or other outpatient visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination;Medical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 60 minutes arespent face-to-face with the patientand/or family.


Q3 0608 0608 $175.79 $176.66Q3

99211 C Office or other outpatient visit for theevaluation and management of anestablished patient, that may notrequire the presence of a physician orother qualified health careprofessional. Usually, the presentingproblem(s) are minimal. Typically, 5minutes are spent performing orsupervising these services.


V 0604 0604 $56.77 $53.84V



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99212 C Office or other outpatient visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Aproblem focused history; A problemfocused examination; Straightforwardmedical decision making. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self limited or minor.Typically, 10 minutes are spent face-to-face with the patient and/or family.


V 0605 0605 $73.68 $72.18V

99213 C Office or other outpatient visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Anexpanded problem focused history; Anexpanded problem focusedexamination; Medical decision makingof low complexity. Counseling andcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low to moderateseverity. Typically, 15 minutes arespent face-to-face with the patientand/or family.


V 0605 0605 $73.68 $72.18V



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99214 C Office or other outpatient visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Adetailed history; A detailedexamination; Medical decision makingof moderate complexity. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 25 minutes arespent face-to-face with the patientand/or family.


V 0606 0606 $96.96 $95.20V

99215 C Office or other outpatient visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Acomprehensive history; Acomprehensive examination; Medicaldecision making of high complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, thepresenting problem(s) are of moderateto high severity. Typically, 40 minutesare spent face-to-face with the patientand/or family.


Q3 0607 0607 $128.48 $130.53Q3



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99217 C Observation care discharge daymanagement (This code is to beutilized to report all services providedto a patient on discharge from"observation status" if the discharge ison other than the initial date of"observation status." To reportservices to a patient designated as"observation status" or "inpatientstatus" and discharged on the samedate, use the codes for Observation orInpatient Care Services [includingAdmission and Discharge Services,99234-99236 as appropriate.])

Cannot be reported on BT 131 under OPPS B B

99218 C Initial observation care, per day, for theevaluation and management of apatient which requires these 3 keycomponents: A detailed orcomprehensive history; A detailed orcomprehensive examination; andMedical decision making that isstraightforward or of low complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, theproblem(s) requiring admission to"observation status" are of lowseverity. Typically, 30 minutes arespent at the bedside and on thepatient's hospital floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99219 C Initial observation care, per day, for theevaluation and management of apatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the problem(s)requiring admission to "observationstatus" are of moderate severity.Typically, 50 minutes are spent at thebedside and on the patient's hospitalfloor or unit.


99220 C Initial observation care, per day, for theevaluation and management of apatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the problem(s)requiring admission to "observationstatus" are of high severity. Typically,70 minutes are spent at the bedsideand on the patient's hospital floor orunit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99221 C Initial hospital care, per day, for theevaluation and management of apatient, which requires these 3 keycomponents: A detailed orcomprehensive history; A detailed orcomprehensive examination; andMedical decision making that isstraightforward or of low complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, theproblem(s) requiring admission are oflow severity. Typically, 30 minutes arespent at the bedside and on thepatient's hospital floor or unit.


99222 C Initial hospital care, per day, for theevaluation and management of apatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the problem(s)requiring admission are of moderateseverity. Typically, 50 minutes arespent at the bedside and on thepatient's hospital floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99223 C Initial hospital care, per day, for theevaluation and management of apatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the problem(s)requiring admission are of highseverity. Typically, 70 minutes arespent at the bedside and on thepatient's hospital floor or unit.


99224 C Subsequent observation care, per day,for the evaluation and management ofa patient, which requires at least 2 ofthese 3 key components: Problemfocused interval history; Problemfocused examination; Medical decisionmaking that is straightforward or of lowcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isstable, recovering, or improving.Typically, 15 minutes are spent at thebedside and on the patient's hospitalfloor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99225 C Subsequent observation care, per day,for the evaluation and management ofa patient, which requires at least 2 ofthese 3 key components: An expandedproblem focused interval history; Anexpanded problem focusedexamination; Medical decision makingof moderate complexity. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isresponding inadequately to therapy orhas developed a minor complication.Typically, 25 minutes are spent at thebedside and on the patient's hospitalfloor or unit.


99226 C Subsequent observation care, per day,for the evaluation and management ofa patient, which requires at least 2 ofthese 3 key components: A detailedinterval history; A detailedexamination; Medical decision makingof high complexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isunstable or has developed a significantcomplication or a significant newproblem. Typically, 35 minutes arespent at the bedside and on thepatient's hospital floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99231 C Subsequent hospital care, per day, forthe evaluation and management of apatient, which requires at least 2 ofthese 3 key components: A problemfocused interval history; A problemfocused examination; Medical decisionmaking that is straightforward or of lowcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isstable, recovering or improving.Typically, 15 minutes are spent at thebedside and on the patient's hospitalfloor or unit.


99232 C Subsequent hospital care, per day, forthe evaluation and management of apatient, which requires at least 2 ofthese 3 key components: An expandedproblem focused interval history; Anexpanded problem focusedexamination; Medical decision makingof moderate complexity. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isresponding inadequately to therapy orhas developed a minor complication.Typically, 25 minutes are spent at thebedside and on the patient's hospitalfloor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99233 C Subsequent hospital care, per day, forthe evaluation and management of apatient, which requires at least 2 ofthese 3 key components: A detailedinterval history; A detailedexamination; Medical decision makingof high complexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isunstable or has developed a significantcomplication or a significant newproblem. Typically, 35 minutes arespent at the bedside and on thepatient's hospital floor or unit.


99234 C Observation or inpatient hospital care,for the evaluation and management ofa patient including admission anddischarge on the same date, whichrequires these 3 key components: Adetailed or comprehensive history; Adetailed or comprehensiveexamination; and Medical decisionmaking that is straightforward or of lowcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually the presentingproblem(s) requiring admission are oflow severity. Typically, 40 minutes arespent at the bedside and on thepatient's hospital floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99235 C Observation or inpatient hospital care,for the evaluation and management ofa patient including admission anddischarge on the same date, whichrequires these 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually the presentingproblem(s) requiring admission are ofmoderate severity. Typically, 50minutes are spent at the bedside andon the patient's hospital floor or unit.


99236 C Observation or inpatient hospital care,for the evaluation and management ofa patient including admission anddischarge on the same date, whichrequires these 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually the presentingproblem(s) requiring admission are ofhigh severity. Typically, 55 minutes arespent at the bedside and on thepatient's hospital floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99241 C Office consultation for a new orestablished patient, which requiresthese 3 key components: A problemfocused history; A problem focusedexamination; and Straightforwardmedical decision making. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self limited or minor.Typically, 15 minutes are spent face-to-face with the patient and/or family.

Cannot be reported on BT 131 under OPPS E E

99242 C Office consultation for a new orestablished patient, which requiresthese 3 key components: An expandedproblem focused history; An expandedproblem focused examination; andStraightforward medical decisionmaking. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low severity.Typically, 30 minutes are spent face-to-face with the patient and/or family.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99243 C Office consultation for a new orestablished patient, which requiresthese 3 key components: A detailedhistory; A detailed examination; andMedical decision making of lowcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate severity.Typically, 40 minutes are spent face-to-face with the patient and/or family.


99244 C Office consultation for a new orestablished patient, which requiresthese 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 60 minutes arespent face-to-face with the patientand/or family.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99245 C Office consultation for a new orestablished patient, which requiresthese 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 80 minutes arespent face-to-face with the patientand/or family.


99251 C Inpatient consultation for a new orestablished patient, which requiresthese 3 key components: A problemfocused history; A problem focusedexamination; and Straightforwardmedical decision making. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self limited or minor.Typically, 20 minutes are spent at thebedside and on the patient's hospitalfloor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99252 C Inpatient consultation for a new orestablished patient, which requiresthese 3 key components: An expandedproblem focused history; An expandedproblem focused examination; andStraightforward medical decisionmaking. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low severity.Typically, 40 minutes are spent at thebedside and on the patient's hospitalfloor or unit.


99253 C Inpatient consultation for a new orestablished patient, which requiresthese 3 key components: A detailedhistory; A detailed examination; andMedical decision making of lowcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate severity.Typically, 55 minutes are spent at thebedside and on the patient's hospitalfloor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99254 C Inpatient consultation for a new orestablished patient, which requiresthese 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 80 minutes arespent at the bedside and on thepatient's hospital floor or unit.


99255 C Inpatient consultation for a new orestablished patient, which requiresthese 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 110 minutes arespent at the bedside and on thepatient's hospital floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99281 C Emergency department visit for theevaluation and management of apatient, which requires these 3 keycomponents: A problem focusedhistory; A problem focusedexamination; and Straightforwardmedical decision making. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self limited or minor.


V 0609 0609 $51.82 $50.28V

99282 C Emergency department visit for theevaluation and management of apatient, which requires these 3 keycomponents: An expanded problemfocused history; An expanded problemfocused examination; and Medicaldecision making of low complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, thepresenting problem(s) are of low tomoderate severity.


V 0613 0613 $92.16 $86.54V



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99283 C Emergency department visit for theevaluation and management of apatient, which requires these 3 keycomponents: An expanded problemfocused history; An expanded problemfocused examination; and Medicaldecision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate severity.


V 0614 0614 $143.36 $136.17V

99284 C Emergency department visit for theevaluation and management of apatient, which requires these 3 keycomponents: A detailed history; Adetailed examination; and Medicaldecision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of high severity, andrequire urgent evaluation by thephysician physicians, or other qualifiedhealth care professionals but do notpose an immediate significant threat tolife or physiologic function.


Q3 0615 0615 $229.37 $219.00Q3



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99285 C Emergency department visit for theevaluation and management of apatient, which requires these 3 keycomponents within the constraintsimposed by the urgency of thepatient's clinical condition and/ormental status: A comprehensivehistory; A comprehensive examination;and Medical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of high severity andpose an immediate significant threat tolife or physiologic function.


Q3 0616 0616 $344.71 $323.58Q3

99288 C Physician or other qualified health careprofessional direction of emergencymedical systems (EMS) emergencycare, advanced life support




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99304 C Initial nursing facility care, per day, forthe evaluation and management of apatient, which requires these 3 keycomponents: A detailed orcomprehensive history; A detailed orcomprehensive examination; andMedical decision making that isstraightforward or of low complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, theproblem(s) requiring admission are oflow severity. Typically, 25 minutes arespent at the bedside and on thepatient's facility floor or unit.


99305 C Initial nursing facility care, per day, forthe evaluation and management of apatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the problem(s)requiring admission are of moderateseverity. Typically, 35 minutes arespent at the bedside and on thepatient's facility floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99306 C Initial nursing facility care, per day, forthe evaluation and management of apatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the problem(s)requiring admission are of highseverity. Typically, 45 minutes arespent at the bedside and on thepatient's facility floor or unit.


99307 C Subsequent nursing facility care, perday, for the evaluation andmanagement of a patient, whichrequires at least 2 of these 3 keycomponents: A problem focusedinterval history; A problem focusedexamination; Straightforward medicaldecision making. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isstable, recovering, or improving.Typically, 10 minutes are spent at thebedside and on the patient's facilityfloor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99308 C Subsequent nursing facility care, perday, for the evaluation andmanagement of a patient, whichrequires at least 2 of these 3 keycomponents: An expanded problemfocused interval history; An expandedproblem focused examination; Medicaldecision making of low complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, thepatient is responding inadequately totherapy or has developed a minorcomplication. Typically, 15 minutes arespent at the bedside and on thepatient's facility floor or unit.


99309 C Subsequent nursing facility care, perday, for the evaluation andmanagement of a patient, whichrequires at least 2 of these 3 keycomponents: A detailed intervalhistory; A detailed examination;Medical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient hasdeveloped a significant complication ora significant new problem. Typically,25 minutes are spent at the bedsideand on the patient's facility floor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99310 C Subsequent nursing facility care, perday, for the evaluation andmanagement of a patient, whichrequires at least 2 of these 3 keycomponents: A comprehensive intervalhistory; A comprehensive examination;Medical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. The patient may beunstable or may have developed asignificant new problem requiringimmediate physician attention.Typically, 35 minutes are spent at thebedside and on the patient's facilityfloor or unit.


99318 C Evaluation and management of apatient involving an annual nursingfacility assessment, which requiresthese 3 key components: A detailedinterval history; A comprehensiveexamination; and Medical decisionmaking that is of low to moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isstable, recovering, or improving.Typically, 30 minutes are spent at thebedside and on the patient's facilityfloor or unit.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99324 C Domiciliary or rest home visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A problem focusedhistory; A problem focusedexamination; and Straightforwardmedical decision making. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low severity.Typically, 20 minutes are spent withthe patient and/or family or caregiver.


99325 C Domiciliary or rest home visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: An expanded problemfocused history; An expanded problemfocused examination; and Medicaldecision making of low complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, thepresenting problem(s) are of moderateseverity. Typically, 30 minutes arespent with the patient and/or family orcaregiver.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99326 C Domiciliary or rest home visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A detailed history; Adetailed examination; and Medicaldecision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 45 minutes arespent with the patient and/or family orcaregiver.


99327 C Domiciliary or rest home visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of high severity.Typically, 60 minutes are spent withthe patient and/or family or caregiver.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99328 C Domiciliary or rest home visit for theevaluation and management of a newpatient, which requires these 3 keycomponents: A comprehensive history;A comprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isunstable or has developed a significantnew problem requiring immediatephysician attention. Typically, 75minutes are spent with the patientand/or family or caregiver.


99334 C Domiciliary or rest home visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Aproblem focused interval history; Aproblem focused examination;Straightforward medical decisionmaking. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self-limited or minor.Typically, 15 minutes are spent withthe patient and/or family or caregiver.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99335 C Domiciliary or rest home visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Anexpanded problem focused intervalhistory; An expanded problem focusedexamination; Medical decision makingof low complexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low to moderateseverity. Typically, 25 minutes arespent with the patient and/or family orcaregiver.


99336 C Domiciliary or rest home visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Adetailed interval history; A detailedexamination; Medical decision makingof moderate complexity. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. Typically, 40 minutes arespent with the patient and/or family orcaregiver.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99337 C Domiciliary or rest home visit for theevaluation and management of anestablished patient, which requires atleast 2 of these 3 key components: Acomprehensive interval history; Acomprehensive examination; Medicaldecision making of moderate to highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate to highseverity. The patient may be unstableor may have developed a significantnew problem requiring immediatephysician attention. Typically, 60minutes are spent with the patientand/or family or caregiver.


99341 C Home visit for the evaluation andmanagement of a new patient, whichrequires these 3 key components: Aproblem focused history; A problemfocused examination; andStraightforward medical decisionmaking. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low severity.Typically, 20 minutes are spent face-to-face with the patient and/or family.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99342 C Home visit for the evaluation andmanagement of a new patient, whichrequires these 3 key components: Anexpanded problem focused history; Anexpanded problem focusedexamination; and Medical decisionmaking of low complexity. Counselingand/or coordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of moderate severity.Typically, 30 minutes are spent face-to-face with the patient and/or family.


99343 C Home visit for the evaluation andmanagement of a new patient, whichrequires these 3 key components: Adetailed history; A detailedexamination; and Medical decisionmaking of moderate complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, thepresenting problem(s) are of moderateto high severity. Typically, 45 minutesare spent face-to-face with the patientand/or family.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99344 C Home visit for the evaluation andmanagement of a new patient, whichrequires these 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of high severity.Typically, 60 minutes are spent face-to-face with the patient and/or family.


99345 C Home visit for the evaluation andmanagement of a new patient, whichrequires these 3 key components: Acomprehensive history; Acomprehensive examination; andMedical decision making of highcomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the patient isunstable or has developed a significantnew problem requiring immediatephysician attention. Typically, 75minutes are spent face-to-face with thepatient and/or family.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99347 C Home visit for the evaluation andmanagement of an established patient,which requires at least 2 of these 3key components: A problem focusedinterval history; A problem focusedexamination; Straightforward medicaldecision making. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are self limited or minor.Typically, 15 minutes are spent face-to-face with the patient and/or family.


99348 C Home visit for the evaluation andmanagement of an established patient,which requires at least 2 of these 3key components: An expandedproblem focused interval history; Anexpanded problem focusedexamination; Medical decision makingof low complexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are of low to moderateseverity. Typically, 25 minutes arespent face-to-face with the patient




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99349 C Home visit for the evaluation andmanagement of an established patient,which requires at least 2 of these 3key components: A detailed intervalhistory; A detailed examination;Medical decision making of moderatecomplexity. Counseling and/orcoordination of care with otherphysicians, other qualified health careprofessionals, or agencies areprovided consistent with the nature ofthe problem(s) and the patient's and/orfamily's needs. Usually, the presentingproblem(s) are moderate to highseverity. Typically, 40 minutes arespent face-to-face with the patientand/or family.


99350 C Home visit for the evaluation andmanagement of an established patient,which requires at least 2 of these 3key components: A comprehensiveinterval history; A comprehensiveexamination; Medical decision makingof moderate to high complexity.Counseling and/or coordination of carewith other physicians, other qualifiedhealth care professionals, or agenciesare provided consistent with the natureof the problem(s) and the patient'sand/or family's needs. Usually, thepresenting problem(s) are of moderateto high severity. The patient may beunstable or may have developed asignificant new problem requiringimmediate physician attention.Typically, 60 minutes are spent face-to-face with the patient and/or family.




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99360 C Standby service, requiring prolongedattendance, each 30 minutes (eg,operative standby, standby for frozensection, for cesarean/high riskdelivery, for monitoring EEG)


99374 C Supervision of a patient under care ofhome health agency (patient notpresent) in home, domiciliary orequivalent environment (eg,Alzheimer's facility) requiring complexand multidisciplinary care modalitiesinvolving regular development and/orrevision of care plans by thatindividual, review of subsequentreports of patient status, review ofrelated laboratory and other studies,communication (including telephonecalls) for purposes of assessment orcare decisions with health careprofessional(s), family member(s),surrogate decision maker(s) (eg, legalguardian) and/or key caregiver(s)involved in patient's care, integration ofnew information into the medicaltreatment plan and/or adjustment ofmedical therapy, within a calendarmonth; 15-29 minutes




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99375 C Supervision of a patient under care ofhome health agency (patient notpresent) in home, domiciliary orequivalent environment (eg,Alzheimer's facility) requiring complexand multidisciplinary care modalitiesinvolving regular development and/orrevision of care plans by thatindividual, review of subsequentreports of patient status, review ofrelated laboratory and other studies,communication (including telephonecalls) for purposes of assessment orcare decisions with health careprofessional(s), family member(s),surrogate decision maker(s) (eg, legalguardian) and/or key caregiver(s)involved in patient's care, integration ofnew information into the medicaltreatment plan and/or adjustment ofmedical therapy, within a calendarmonth; 30 minutes or more




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99377 C Supervision of a hospice patient(patient not present) requiring complexand multidisciplinary care modalitiesinvolving regular development and/orrevision of care plans by thatindividual, review of subsequentreports of patient status, review ofrelated laboratory and other studies,communication (including telephonecalls) for purposes of assessment orcare decisions with health careprofessional(s), family member(s),surrogate decision maker(s) (eg, legalguardian) and/or key caregiver(s)involved in patient's care, integration ofnew information into the medicaltreatment plan and/or adjustment ofmedical therapy, within a calendarmonth; 15-29 minutes


99378 C Supervision of a hospice patient(patient not present) requiring complexand multidisciplinary care modalitiesinvolving regular development and/orrevision of care plans by thatindividual, review of subsequentreports of patient status, review ofrelated laboratory and other studies,communication (including telephonecalls) for purposes of assessment orcare decisions with health careprofessional(s), family member(s),surrogate decision maker(s) (eg, legalguardian) and/or key caregiver(s)involved in patient's care, integration ofnew information into the medicaltreatment plan and/or adjustment ofmedical therapy, within a calendarmonth; 30 minutes or more




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99379 C Supervision of a nursing facility patient(patient not present) requiring complexand multidisciplinary care modalitiesinvolving regular development and/orrevision of care plans by thatindividual, review of subsequentreports of patient status, review ofrelated laboratory and other studies,communication (including telephonecalls) for purposes of assessment orcare decisions with health careprofessional(s), family member(s),surrogate decision maker(s) (eg, legalguardian) and/or key caregiver(s)involved in patient's care, integration ofnew information into the medicaltreatment plan and/or adjustment ofmedical therapy, within a calendarmonth; 15-29 minutes


99380 C Supervision of a nursing facility patient(patient not present) requiring complexand multidisciplinary care modalitiesinvolving regular development and/orrevision of care plans by thatindividual, review of subsequentreports of patient status, review ofrelated laboratory and other studies,communication (including telephonecalls) for purposes of assessment orcare decisions with health careprofessional(s), family member(s),surrogate decision maker(s) (eg, legalguardian) and/or key caregiver(s)involved in patient's care, integration ofnew information into the medicaltreatment plan and/or adjustment ofmedical therapy, within a calendarmonth; 30 minutes or more




E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99441 C Telephone evaluation andmanagement service by a physician orother qualified health care professionalwho may report evaluation andmanagement services provided to anestablished patient, parent, orguardian not originating from a relatedE/M service provided within theprevious 7 days nor leading to an E/Mservice or procedure within the next 24hours or soonest availableappointment; 5-10 minutes of medicaldiscussion






E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI



99444 C Online evaluation and managementservice provided by a physician orother qualified health care professionalwho may report an evaluation andmanagement services provided to anestablished patient or guardian, notoriginating from a related E/M serviceprovided within the previous 7 days,using the Internet or similar electroniccommunications network


99464 C Attendance at delivery (whenrequested by the delivering physicianor other qualified health careprofessional) and initial stabilization ofnewborn

Revised with the addition of words "or otherqualified healthcare professional".

N N



E/M


2013APC

2013Payment

2012Payment

2012APC

2012SI

99466 C Critical care face-to-face services,during an interfacility transport ofcritically ill or critically injured pediatricpatient, 24 months of age or younger;first 30-74 minutes of hands-on careduring transport

Editorial change with added informationrelative to age of the pediatric patient andthe amount of face-to-face time spent.

N N

99467 C Critical care face-to-face services,during an interfacility transport ofcritically ill or critically injured pediatricpatient, 24 months of age or younger;each additional 30 minutes (Listseparately in addition to code forprimary service)

Editorial change with added informationrelative to age of the pediatric patient andthe amount of face-to-face time spent.

N N


outpatient revenue cycle update for 2013 – cpt/hcpcs · outpatient revenue cycle update for 2013...

Documents