CPT^® 99204, Under New Patient

The Current Procedural Terminology (CPT^®) code 99204 as maintained by American Medical Association, is a medical procedural code under the range - New Patient.

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Summary

The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider spends 45 or more minutes of total time on the encounter on a single date.

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View matching HCPCS Level II codes and their definitions.

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MDM for glasses and/or contact lenses?

That isn't correct. It has to be prescription MEDICATIONS, not prescription lenses. Did the doctor only code refractive codes for the 99204? If so, that wouldn't qualify as a medical visit. Tom Cheez... [ Read More ]

MDM for glasses and/or contact lenses?

I have a provider who billed a 99204 and used prescription drug management for the RX of contact lenses. Is this acceptable? I can't find anything on it, besides contacts/glasses are considered a medi... [ Read More ]

Addiction Recovery Billing #addictioncoding 99213 99214

Hello! I work at an addiction recovery office who give Vivitrol injections to our patients. My bosses feel that we should be billing 99204 and 99214 more. I'm concerned that this is going to cause a l... [ Read More ]

why use the 1995 Medicare guidelines over 1997?

I totally agree here with [USER=29238]@Orthocoderpgu[/USER]. I once had it explained to me as Medicare came out with the 1995 guidelines. There were some subspecialties who do a very detailed examin... [ Read More ]

Billing based upon MDM for an E/M

Hello, Our auditor states that "If the physician is not billing based upon time - the attempt to add up the time spent based upon the code is not relevant. As we know, when billing based upon MDM, a ... [ Read More ]

96132,96136,96137 HELP Sports medicine provider

I don't bill sports medicine, but my guess is the E/M and additional codes are NCCI edits. When I ran 99204 with 96136 for example, it comes up as bundled, but may be overriden with a modifier only i... [ Read More ]

E/M auditing

New patient was seen for Hidradenitis Suppurativa. Two prescriptions, labs ordered, intralesional injection, and I&D performed. Provider coded a 99204 as well as coded for procedures. My question i... [ Read More ]

level 3 or level 4

FYI - in general, it would be great to post what YOU are coming up with and why, then ask for assistance. [URL]https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf[/... [ Read More ]

blue shield reimbursement on 99204/99205

[QUOTE="jstickfort, post: 507085, member: 253113"] Every time we bill for 99205 or 99204 to Blue Shield we get a request for medical records and then a denial, never fails. If we downcode we get pai... [ Read More ]

blue shield reimbursement on 99204/99205

Hi Jtickfort Using the CPT 99204 and 99205 must be justified...per the CPT manual almost near death or complex case or must go to EMR from your office. Is this the first visit for THIS injury by you... [ Read More ]

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