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new established codes 99201-05 and 99211-215 question

  1. Default new established codes 99201-05 and 99211-215 question
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    My company is starting to bill Urgent care office visits. should we go by the 1997 points system rules by cms or is this done differently to formulate the cpt codes above? ellen

  2. #2
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    I am not 100% sure I understand your question.

    Are you asking whether to use the 1997 E/M CMS guidelines or something else for New Patient/Established Patient visits when determining the E/M level of Urgent Care visits?

    CMS has given providers the option to use either 1995 or 1997 E/M guidelines. Each has their own benefits and drawbacks, however if you choose one set of guidelines, you must stick with it throughout your whole audit. Meaning, if you audit the Exam portion with 1997 guidelines, you'll need to stick to that set for the History and MDM portions as well.

    Hopefully that answers your questions, if not feel free to specify further.
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

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