E&M Codes – Coding for Clinicians

Description	Codes	Explanations	Work RVU	Total RVU	Complexity of Data	Risk of Morbidity
Subsequent Hospital Care Level I, 15 minutes	99231		99231 - 0.76	99231 - 1.11
Subsequent Hospital Care Level II, 25 minutes	99232		99232 - 1.39	99232 - 2.04
Subsequent Hospital Care Level III, 35 minutes	99233		99233 - 2.00	99233 - 2.95
Emergency Dept - New or Established I	99281		99281 - 0.45	99281 - 0.60
Emergency Dept - New or Established II	99282		99282 - 0.88	99282 - 1.17
Emergency Dept - New or Established III	99283		99283 - 1.34	99283 - 1.75
Emergency Dept - New or Established IV	99284		99284 - 2.56	99284 - 3.32
Emergency Dept - New or Established V	99285		99285 - 3.80	99285 - 4.90
Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure	99024	Starting July 1, 2017, for Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island, this code now must be on Medicare fee-for-service claims for outpatient and inpatient post-operative follow-up visits.	99024 - 0.00	99024 - 0.00
Hospital Discharge Day	99239	>30 minutes	99239 - 1.90	99239 - 3.04
Hospital Discharge Day	99238	<30 minutes	99238 - 1.28	99238 - 2.05
Critical Care Total Time	99291	1st 30 - 74 min	99291 - 4.50	99291 - 6.32
Critical Care Total Time	99292	Plus 30 min	99292 - 2.25	99292 - 3.17
Initial Inpatient Consult Level I, 20 minutes	99251	This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers.	99251 - 1.00	99251 - 1.38
Initial Inpatient Consult Level II, 40 minutes	99252	This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers.	99252 - 1.50	99252 - 2.11
Initial Inpatient Consult Level III, 55 minutes	99253	This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers.	99253 - 2.27	99253 - 3.24
Initial Inpatient Consult Level IV, 80 minutes	99254	This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers.	99254 - 3.29	99254 - 4.71
Initial Inpatient Consult Level V, 110 minutes	99255	This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers.	99255 - 4.00	99255 - 5.68
Initial Hospital Care Level I, 30 minutes	99221	This code is the Medicare allowable code for hospital history & physical and consults.	99221 - 1.92	99221 - 2.87
Initial Hospital Care Level II, 50 minutes	99222	This code is the Medicare allowable code for hospital history & physical and consults.	99222 - 2.61	99222 - 3.87
Initial Hospital Care Level III, 70 minutes	99223	This code is the Medicare allowable code for hospital history & physical and consults.	99223 - 3.86	99223 - 5.73
Observation care discharge	99217		99217 - 1.28	99217 - 2.06
Initial observation care, 30 minutes	99218		99218 - 1.92	99218 - 2.82
Initial observation care, 50 minutes	99219		99219 - 2.60	99219 - 3.84
Initial observation care, 70 minutes	99220		99220 - 3.56	99220 - 5.25
Office consultation, 15 minutes	99241		99241 - 0.64	99241 - 0.92
Office consultation, 30 minutes	99242		99242 - 1.34	99242 - 1.93
Office consultation, 40 minutes	99243		99243 - 1.88	99243 - 2.70
Office consultation, 60 minutes	99244		99244 - 3.02	99244 - 6.04
Office consultation, 80 minutes	99245		99245 - 3.77	99245 - 7.54
Office or other outpatient visit for the evaluation, 10 minutes	99201		99201 - 0.48	99201 - 0.96
Office or other outpatient visit for the evaluation, 15-29 minutes	99202	Minimal; 1 self-limited or minor problem	99202 - 0.93	99202 - 1.86	Minimal or none	Minimal risk of morbidity from additional diagnostic testing or treatment
Office or other outpatient visit for the evaluation, 30-44 minutes	99203	Low; 2 or more self-limited or minor problems; 1 stable chronic illness; 1 acute, uncomplicated illness or injury	99203 - 1.42	99203 - 2.84	Limited (must meet the requirements of at least 1 of the 2 categories) Category 1: Tests and documents Any combination of 2 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test or Category 2: Assessment requiring an independent hisotrian(s) (for the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high)	Low risk of morbidity from additional diagnostic testing or treatment
Office or other outpatient visit for the evaluation, 45-59 minutes	99204	Moderate; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 2 or more stable chronic illness; 1 undiagnosed new problem with uncertain prognosis; 1 acute illness with systemic symptoms; 1 acute complicated injury	99204 - 2.43	99204 - 4.86	Moderate (must meet the requirements of at least 1 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)	Moderate risk of morbidity from additional diagnostic testing or treatment
Office or other outpatient visit for the evaluation, 60-74 minutes	99205	High; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 1 acute or chronic illness or injury that poses a threat to life or bodily function.	99205 - 3.17	99205 - 6.34	Extensive (must meet the requirements of at least 2 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)	High risk of morbidity from additional diagnostic testing or treatment
Office/outpatient visit N/A	99211	Does not require a clinician and visit may be done by office staff	99211 - 0.18	99211 - 0.36
Office/outpatient visit est, 10-19 minutes	99212	Minimal; 1 self-limited or minor problem	99212 - 0.48	99212 - 0.96	Minimal or none	Minimal risk of morbidity from additional diagnostic testing or treatment
Office/outpatient visit est, 20-29 minutes	99213	Low; 2 or more self-limited or minor problems; 1 stable chronic illness; 1 acute, uncomplicated illness or injury	99213 - 0.97	99213 - 1.94	Limited (must meet the requirements of at least 1 of the 2 categories. Category 1: Tests and documents Any combination of 2 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test or Category 2: Assessment requiring an independent hisotrian(s) (for the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high)	Low risk of morbidity from additional diagnostic testing or treatment
Office/outpatient visit est, 30-39 minutes	99214	Moderate; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 2 or more stable chronic illness; 1 undiagnosed new problem with uncertain prognosis; 1 acute illness with systemic symptoms; 1 acute complicated injury	99214 - 1.50	99214 - 3.00	Moderate (must meet the requirements of at least 1 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)	Moderate risk of morbidity from additional diagnostic testing or treatment
Office/outpatient visit est, 40-54 minutes	99215	High; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 1 acute or chronic illness or injury that poses a threat to life or bodily function.	99215 - 2.11	99215 - 4.22	Extensive (must meet the requirements of at least 2 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)	High risk of morbidity from additional diagnostic testing or treatment
Reimbursable PR2 chart notes	99081		99081 - 0.00	99081 - 0.00
Phone call 5 to 10 minutes of medical discussion	98966		98966 - 0.25	98966 - 0.5
Phone call 11 to 20 minutes of medical discussion	98967		98967 - 0.50	98967 - 1.00
Phone call 21 to 30 minutes of medical discussion	98968		98968 - 0.75	98968 - 1.50
Email or some other online service to discuss a medical problem with a physician.	99444		99444 - 0.00	99444 - 0.00
Email or some other online service to discuss a medical problem with a physician extender.	98969		98969 - 0.00	98969 - 0.00
5-10 minutes of medical consultative discussion and review	99446		99446 - 0.35	99446 - 0.70
11-20 minutes of medical consultative discussion and revie	99447		99447 - 0.70	99447 - 1.40
21-30 minutes of medical consultative discussion and review	99448		99448 - 1.05	99448 - 2.10
31 minutes or more of medical consultative discussion and review	99449		99449 - 1.40	99449 - 2.80
Sign language or oral interpretive services, per 15 minutes	T1013		T1013 - 0	T1013 - 0
Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time	99451		99451 - 0.70	99451 - 1.40
Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes	99452		99452 - 0.70	99452 - 1.40
Prolonged evaluation and management service before and/or after direct patient care; first hour	99358		99358 - 1.80	99358 - 3.60
Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service)	99359		99359 - 0.75	99359 - 1.50
ADL 15mins	97535		97535 - 0.45	97535 - 0.90
PR4 P&S (1st page)	WC004-0000		WC004-0000 - 0	WC004-0000 - 0
PR4 P&S (each additional page)	WC004-0001		WC004-0001 - 0	WC004-0001 - 0