EM Coding Alert

Question: The physician provided services to a new patient in a custodial care center. The patient is a 43-year-old paraplegic who has a severe infected stasis ulcer. The physician performed a detailed history and detailed examination and prescribed an antibiotic. Which code should I use?

California Subscriber

Answer: According to the CPT^® manual, for a new patient, you would choose from 99324-99328 (Domiciliary or rest home visitfor the evaluation and management of a new patient, which requires these 3 key components …) to report E/M services that provide room, board, and other personal assistance services, usually on a long-term basis. Domiciliary, rest homes, custodial care services, boarding homes, and assisted living facilities all fall under these code options. According to these definitions, the best code choice is 99326.

Check out your five code choices for reporting custodial care for new patients.

Note: To use any of the codes below, the provider must perform all three key components listed:

• 99324, A problem focused history, a problem focused examination, and straightforward medical decision making. The presenting problem(s) are of low severity and the physician spends 20 minutes with the patient and/or family or caregiver.
• 99325, An expanded problem focused history, an expanded problem focused examination, and low complexity medical decision making. The presenting problem(s) are of moderate severity, and the physician spends 30 minutes with the patient and/or family or caregiver.
• 99326, A detailed history, detailed examination, and moderate complexity medical decision making. The presenting problem(s) are of moderate to high severity, and the physician spends 45 minutes with the patient and/or family or caregiver.
• 99327, A comprehensive history, comprehensive examination, and moderate complexity medical decision making. The presenting problem(s) are of high severity, and the physician spends 60 minutes with the patient and/or family or caregiver.
• 99328, A comprehensive history, comprehensive examination, and high complexity medical decision making. Usually, the patient is unstable or has developed a significant new problem requiring the physician’s immediate attention. The physician spends 75 minutes with the patient and/or family or caregiver.