cpt 99204, cpt code 99204, 99204 cpt code

CPT 99204 | New Patient Outpatient E/M Services (45-59 Minutes)

CPT code 99204 describes an evaluation and management service with a moderate level of medical decision-making and a total time of 45-59 minutes spent on the encounter date provided to a new patient in an outpatient setting.

What Is CPT Code 99204?

CPT 99204 is used for billing an evaluation and management (E/M) service for a new patient in an outpatient setting.

CPT 99204 includes both face-to-face and non-face-to-face activities, such as reviewing tests and preparing for the patient visit, performing the evaluation, counseling and educating the patient or caregiver, and more.

The total time spent on the encounter date is between 45-59 minutes, and the level of medical decision-making involved is moderate.

The visit may also include taking a patient history and performing a physical examination, as determined by the provider.

Medical decision-making refers to evaluating the patient’s medical condition and determining the appropriate course of treatment, considering the number and complexity of problems, the amount and complexity of data to review, and the risk of complications.

Description

The CPT book describes CPT code 99204 as: “Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and a moderate level of medical decision making. When using time for code selection, 45-59 minutes of the total time is spent on the date of the encounter.”

Procedure

The provider conducts an evaluation and management service for a new patient at an outpatient facility.

CPT 99204 includes a wide range of face-to-face and non-face-to-face activities that are necessary for the thorough evaluation and management of the patient’s healthcare needs.

These activities may include reviewing tests and other medical records, preparing for the patient visit, performing the evaluation, counseling and educating the patient or caregiver, ordering additional tests or procedures as necessary, communicating with other healthcare providers to coordinate care, documenting the encounter in the medical record, interpreting and communicating test results, and more.

The total time spent on the encounter date is between 45-59 minutes, and the level of medical decision-making involved is moderate.

This means that the provider will need to consider a moderate number and complexity of problems, a moderate amount and complexity of data to review and analyze, and a moderate risk of complications, morbidity, and mortality in determining the appropriate course of treatment for the patient.

The provider may also conduct a patient history and physical examination as necessary, taking into account the nature and extent of these components as determined by the provider.

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