Wiki 99202 = 99213, not 99212

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Leenahz

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Hi all,

Does anyone have any good resources for the E/M new patient & established patient crosswalk? I have a few people in my agency who are adamant that a 99202 is the equivalent of a 99212; 99203 is the equivalent of 99213, etc. I have my CPT code book, but is there anything out there in black & white by the AMA or CMS I can use a reference to print out? I'm currently in the mental health agency, but have a family practice background and my experience and education has always taught me 99202 = 99213 (if est.), 99203 = 99214 (if est.)

Thank you :)

Lena
 
Hi Lena,

Check out www.fcso.com and click the link Evaluation and Management. The interactive worksheet allows you to choose 1995 or 1997 EM guidelines. Chose "new patient" Work through the sheet using a medical note. When you receive calculation, go back to the top of the page and change to "established patient". Based on documentation and your selections it will reveal the appropriate established EM level.
 
There is no direct crosswalk for new to existing patients. Lets say the doctor had an expanded history, detailed exam and a moderate MDM a new patient would be a 99202 and an existing patient would be a 99214. If we change the MDM to low that would change the existing code to 99213 but the new remains 99202.

Another point to note if your office policy like many insurances requires MDM to be one of the two components met, then if you have expanded history, expanded exam and straightforward MDM it would be a 99202 for new and 99212 for existing.
 
Aperring said:
There is no direct crosswalk for new to existing patients. Lets say the doctor had an expanded history, detailed exam and a moderate MDM a new patient would be a 99202 and an existing patient would be a 99214. If we change the MDM to low that would change the existing code to 99213 but the new remains 99202.

Another point to note if your office policy like many insurances requires MDM to be one of the two components met, then if you have expanded history, expanded exam and straightforward MDM it would be a 99202 for new and 99212 for existing.
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I've yet to experience an insurance company requiring MDM as one of the key components, so I'll have to look into that with the new office I'm at. Thank you for that piece of info!

I did, however, find a crosswalk for E/M key components from the National Council of Behavioral Health and a resource from the APA :)
 
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