Pediatric Coding Alert

Question: Are new-patient office visit codes a step down from established-patient office visit codes? For instance, does a 99202’s requirements equal a 99213’s? Georgia Subscriber Answer: The descriptors for 99202 and 99213 include the same type of history and examination: expanded problem focused. New-patient code 99202 compared to established-patient code 99213 requires one level lower of medical decision making (MDM) (99213 requires low complexity MDM while 99202 requires straightforward MDM). Code 99202, however, requires three of three key components, where as 99213 requires two of three key components, as follows: Code         History Type                                    Examination Type                 MDM Type          Requirements 99213 expanded problem focused              expanded problem focused        low complexity        2/3 99202 expanded problem focused              expanded problem focused        straightforward        3/3 You can use the step down history tool as an easy way to remember the key requirement differences between newand established-patient office visit codes. Remember, new codes 99201-99205 require the physician [...]