E/M Established Outpatient Visit

Aka: E/M Established Outpatient Visit, E/M Established Office Visit, CPT 99211, CPT 99212, CPT 99213, CPT 99214, CPT 99215

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II. Indication

  1. E/M Established Patient

III. Established Outpatient: CPT Code 99211

  1. Key components not required
  2. Physician need not be present (only supervising)
  3. E/M Minimal Problem
  4. Staff Time: 5 minutes

IV. Established Outpatient: CPT Code 99212

  1. Key Components (2 of 3 meet or exceed requirements)
    1. E/M Problem Focused History
    2. E/M Problem Focused Exam
    3. E/M Straightforward Medical Decision
  2. E/M Self Limited or Minor Problem
  3. Physician Time: 10 minutes

V. Established Outpatient: CPT Code 99213

  1. Key Components (2 of 3 meet or exceed requirements)
    1. E/M Expanded Problem Focused History
    2. E/M Expanded Problem Focused Exam
    3. E/M Low Complexity Medical Decision
  2. Problem severity
    1. E/M Low Severity Problem
    2. E/M Moderate Severity Problem
  3. Physician Time: 15 minutes

VI. Established Outpatient: CPT Code 99214

  1. Key Components (2 of 3 meet or exceed requirements)
    1. E/M Detailed History
    2. E/M Detailed Exam
    3. E/M Moderate Complexity Medical Decision
  2. Problem Severity
    1. E/M Moderate Severity Problem
    2. E/M High Severity Problem
  3. Physician Time: 25 minutes

VII. Established Outpatient: CPT Code 99215

  1. Key Components (2 of 3 meet or exceed requirements)
    1. E/M Comprehensive History
    2. E/M Comprehensive Exam
    3. E/M High Complexity Medical Decision
  2. Problem Severity
    1. E/M Moderate Severity Problem
    2. E/M High Severity Problem
  3. Physician Time: 40 minutes

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