Evaluation And Management Section

Question 1

Office and other outpatient services

Answer 1

99202–99215

Question 2

Hospital inpatient and observation care services

Answer 2

99221–99239

Question 3

Consultations

Answer 3

99242–99255

Question 4

Emergency department services

Answer 4

99281–99288

Question 5

Critical care services

Answer 5

99291–99292

Question 6

Nursing facility services

Answer 6

99304–99316

Question 7

Home and residence services

Answer 7

99341–99350

Question 8

Prolonged services

Answer 8

99358–99359, 99415–99418

Question 9

Standby services

Answer 9

99360

Question 10

Case management services

Answer 10

99366–99368

Question 11

Care plan oversight services

Answer 11

99374–99380

Question 12

Preventive medicine services

Answer 12

99381–999429

Question 13

Non-Face-to-face physician services

Answer 13

99421–99458

Question 14

Special evaluation and management services

Answer 14

99450–99456

Question 15

Newborn care services

Answer 15

99460–99463

Question 16

Delivery birthing room attendance, and resuscitation services

Answer 16

99464–99465

Question 17

Inpatient neonatal, intensive care services and pediatric and neonatal critical care services

Answer 17

99466–99486

Question 18

Cognitive assessment and care plan services

Answer 18

99483

Question 19

Care management services

Answer 19

99490–99483, 99490–99437, 99487–99489, 99424–99427

Question 20

Psychiatric collaborative care management services

Answer 20

99492–99494

Question 21

Transitional care management services

Answer 21

99495–99496

Question 22

Advanced care planning

Answer 22

99497, 99498

Question 23

General behavioral health integration care management

Answer 23

99484

Question 24

Other evaluation and management services

Answer 24

99459, 99499

Question 25

When identifying an evaluation and management code, what are the three major questions?

Answer 25

1. Is the patient a new or an established patient?
2. Where was the service provided?
3. What was the level of service rendered?

Question 26

New patient versus establish patient

Answer 26

New- 99202–99205
Established - 99211–99215

NOTE: emergency department service codes, 99281–99285 are for new OR established patients

Question 27

What is the criteria of being a new patient?

Answer 27

A new patient is someone who has not received any professional services from the physician, qualified healthcare professional or from another physician or qualified healthcare, professional of the exact same specialty, or subspecialty who belongs to the same group practice within the past three years.

Ex. You can bill someone who sees a different doctor of different specialties even if they are at the same practice
You can bill someone who is seeing someone of the same specialty, but not at the same practice