What Are the Six Most Commonly Used Procedure Codes?

Evaluation and Management Codes and What They Mean

Medical Bill
lbodvar/Getty Images

Medical coding is a major factor in obtaining insurance reimbursement as well as maintaining patient records. Coding claims accurately lets the insurance payer know the illness or injury of the patient and the method of treatment. Patients may see these codes in their medical records or bills.

Common Systems of Medical Codes

CPT codes are developed by the American Medical Association to identify codes most often used by physicians rendering services in the medical office.

These codes are updated yearly. They are copyrighted by the AMA and the medical offices invest in software that incorporates the ongoing changes or purchase the updated guidebooks every year. Those who don't purchase these resources can look up 12 codes without charge by registering on the AMA website.

HCPCS codes are developed by CMS (Centers for Medicare and Medicaid Services) to identify codes most often used for hospital services, supplies, and drugs. They are alphanumeric codes with one letter followed by four numbers.

Most Frequently Used Medical Procedure Codes

The most frequently used codes are medical Evaluation and Management (E/M) codes, which are part of the CPT code system. They are included in the range of numbers from 90000 to 99999. They are specific for the setting of the services (outpatient, inpatient, emergency, nursing facility) and for four different types of examinations (problem focused, expanded problem focused, detailed, and comprehensive).

These are the six most commonly used medical procedure codes:

  1.  New Patient Office Visit (99201-05): These medical codes are used to bill for patients never seen by any physician in the same specialty within the same group within the last three years. 99201: Problem focused. 99202: Expanded problem focused. 99203: Detailed. 99204: Comprehensive, moderate. 99205: Comprehensive, high.
  1. Established Patient Office Visit (99211-15): These medical codes are used to bill for patients that have been seen by any physician in the same specialty within the same group within the last three years. 99212: Problem focused. 99213: Expanded problem focused. 99214: Detailed. 99215: Comprehensive.
  2. Initial Hospital Care for New or Established Patient (99221-23):  These medical codes are used to bill for patients that are admitted to a hospital.
  3. 99231-23: Subsequent Hospital Care
  4. 99281-85: Emergency Department Visits
  5. 99241-45: Office Consultations. These are patients seeking the opinion of a physician at the request of another physician. 99241: Problem focused. 99242: Expanded problem focused. 99243: Detailed. 99244: Comprehensive, moderate. 99245: Comprehensive, high.

The level of service depends on the documentation of the history, physical examination and medical decision-making. The physician must provide enough detail to support the level of service. A problem focused visit evaluates one to five elements within a system. An expanded problem focused visit evaluates at least six elements. A detailed visit evaluates at least two elements in six systems or 12 elements in two or more systems.

A comprehensive exam evaluates the entire review of systems, identifying one or two elements per system.

In addition to accurate coding of treatment, medical claims must be billed in combination with codes for additional services performed in the office, the corresponding modifiers, if necessary, and ICD-9 or diagnosis codes.

Source:

Choat DE. Coding for office procedures and activities. Clinics in Colon and Rectal Surgery. 2005;18(04):279–284. doi:10.1055/s-2005-922852.

Continue Reading