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Thread: 99204 vs 99203 Ortho

  1. #1
    Join Date
    Apr 2007

    Default 99204 vs 99203 Ortho

    AAPC: Back to School
    Hello, I would like to know how others would code this scenario.... We are a specialty Orthopedics practice and one of our docs does total knees and hips. He says if a new pt comes to our practice that needs a total joint replacement he can bill a 99204. I was always told as a specialty practice we would not met the criteria for this high of a level (on a new pt) due to It would not be medically necessary to do the full review of symptoms(1997 guidelines). Thanks for any response!!!

  2. #2
    Join Date
    Apr 2007
    Athens, Ga.


    I think you have been informed incorrectly. I work for a specialist and we bill 99204 regularly. I suggest you get a copy of the 1997 E&M Documentation Guidelines and familiarize yourself with the requirements. As long as your documentation supports the service, you can bill it.
    Walker Bachman, CPC, CPPM

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