Visits

New Office Patients

These codes are used to report E/M services for new office patients. There used to be five levels of care for these encounters, but now there are only four. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient in order to optimize reimbursement.

Established Office Patients

These codes are used to report E/M services for established office patients. There are five levels of care. There is significant variation in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the encounter in order to optimize reimbursement.

Initial Hospital Care

These codes are used to report initial hospital care services (otherwise known as admission H&Ps). These codes are used for both inpatients and observation care patients. There are three levels of care for these services. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Subsequent Hospital Care Services

These codes are used to report subsequent hospital care services (also known as hospital progress notes). Use these codes to report subsequent hospital care services for both inpatients and observation care patients. There are three levels of care for these services. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Emergency Services

These codes are used to report emergency department E/M services. There are five levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Critical Care

Critical care is the direct delivery by a physician of medical care for a critically ill or injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition.

Consult Services

Medicare stopped paying for consult services on January 1, 2010. Some private insurers continue to pay for these services. These codes are used to report consult services in both the outpatient and inpatient settings. There used to be five levels of care for these services, but now there are only four.

Initial Nursing Care Facility Services

These codes are used to report initial nursing facility care services. Initial nursing facility care services provide the initial comprehensive assessment during which the physician completes a thorough evaluation, develops a plan of care and writes or verifies admitting orders for the nursing facility resident.

Subsequent Nursing Facility Care Services

These codes are used to report subsequent nursing facility care services. Subsequent nursing facility care services are defined as encounters that take place in a nursing facility after the initial nursing facility care evaluation.

New Home Visits

Use these codes to report initial nursing facility visits. There are four levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Established Home Visits

Use these codes to report home visits for established patients. There are four levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Admission & Discharge on the Same Date

Use these codes to report admission and discharge services for inpatients or observation care patients when the patient is admitted and discharged on the same calendar date. There are three levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Hospital Discharge Services

Use these time-based codes to report discharge services for hospital inpatients or observation care patients. There are two levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.

Nursing Facility Discharge Services

Use these time-based codes to report discharge services for nursing facility patients. There are two levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.