This article continues a series that serves 2 purposes.
Separate code categories are used to report services provided to new patients (99202–99205) versus established patients (99212–99215) for office and other outpatient E/M services. Here is the Current Procedural Terminology (CPT®) guideline for determining when a patient is new versus established.
The required levels of MDM are the same for new and established patients at each level of office E/M service (eg, high MDM supports either code 99205 or 99215). However, the new patient codes are assigned values that include additional practice expense associated with adding a new patient to the practice (eg, creating a new medical record, obtaining prior medical records).
The process of determining the level of MDM begins with referencing “Table 2: Levels of Medical Decision Making (MDM)” in the CPT guidelines for E/M services. This table lists...