| Evaluation &
Management - 2006 Codes |
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Confirmatory Consultations
In 2006, confirmatory consultation codes, 99271-99275, were deleted,
because physicians often used them incorrectly and because other existing
E/M codes can be used.
- Use the office or other outpatient consultation codes, 99241-99245,
to report a confirmatory consultation furnished to a new or
established patient in the office.
- Use the initial inpatient consultation codes, 99251-99255,
to report a confirmatory consultation furnished to a new or
established patient in the hospital.
- Append modifier -32 when the confirmatory consultation is mandatory,
such as one required by a payer.
2006 introduces a new family of Nursing Home Codes.
| New |
Description
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| 99300 |
Subsequent Intensive Care, per day, for the E & M
of the recovering infant (present body weight of 2501-5000
grams) |
CPT codes 99301-99303 and 99311-13 have been Deleted .
| New |
Description
|
| 99304-99306 |
Initial nursing facility
care, per day - Click for Table |
| 99307-99310 |
Subsequent nursing facility care, per day |
| 99318 |
Annual nursing facility assessment |
Discharge codes 99315 and 99316 were unchanged.
CPT includes three codes for Comprehensive Nursing Facility
Assessments: an annual assessment (99301); an assessment for a major
permanent change of status (99302); and, an assessment at the time of
admission (99303).
In 2005 there were only three levels of service for established
patients in the Subsequent Nursing Facility Care subsection of
CPT, and
that the highest level of service is restricted to a detailed interval
history and a detailed examination. This is inconsistent with current
clinical practice. To correct this problem, a new fourth level of
service code has been added in 2006 to permit the reporting of a
comprehensive level of service.
There is a new code in a new subsection (Other Nursing Facility Care)
to allow the reporting of a comprehensive annual assessment.
"This is a service that is unique to the NF setting and the
extent of history and examination and the complexity of medical decision
making are not well described by the other E & M codes in this
section."
| New |
Description
|
| 99324-99328 |
Domiciliary or Rest Home (eg, Boarding Home), or Custodial Care
Services, guidelines now state including assisted living
facility, New patient |
| 99334-99337 |
Domiciliary or Rest Home (eg, Boarding Home), or Custodial Care
Services, guidelines now state including assisted living
facility, Established patient |
| 99339-99340 |
Domiciliary, Rest Home (e.g., Assisted Living Facility), or Home
Care Plan Oversight Services (similar to care plan
oversight codes for home health/hospice) |
| E &
M Nursing Facility Codes |
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New descriptors for the redefined Nursing Facility Code family.
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99304 Initial nursing facility care, per day, for the
evaluation and management of a patient which requires these three key
components:
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a detailed or comprehensive history;
a detailed or comprehensive examination; and
medical decision making that is straightforward or of low complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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Usually, the problem(s) requiring admission are of low severity.
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99305 Initial nursing facility care, per day, for the evaluation and
management of a patient which requires these three key components:
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a comprehensive history;
a comprehensive examination; and
medical decision making of moderate complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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Usually, the problem(s) requiring admission are of moderate severity.
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99306 Initial nursing facility care, per day, for the evaluation and
management of a patient, which requires these three key components:
|
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a comprehensive history;
a comprehensive examination; and
medical decision making of high complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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Usually, the problem(s) requiring admission are of high severity.
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99307 Subsequent nursing facility care, per day, for the evaluation
and management of a patient, which requires at least two of these three
key components:
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a problem focused interval history;
a problem focused examination;
straightforward medical decision making.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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Usually, the patient is stable, recovering, or improving.
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99308 Subsequent nursing facility care, per day, for the evaluation
and management of a patient, which requires at least two of these three
key components:
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an expanded problem focused interval history;
an expanded problem focused examination;
medical decision making of low complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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Usually, the patient is responding inadequately to therapy or has
developed a minor complication.
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99309 Subsequent nursing facility care, per day, for the evaluation
and management of a patient, which requires at least two of these three
key components:
|
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a detailed interval history;
a detailed examination;
medical decision making of moderate complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
|
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Usually, the patient has developed a significant complication or a
significant new problem.
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99310 Subsequent nursing facility care, per day, for the evaluation
and management of a patient, which requires at least two of these three
key components:
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Hx: comprehensive interval history;
Exam: comprehensive examination;
medical decision making: high complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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The patient may be unstable or may have developed a significant new
problem requiring immediate physician attention.
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The Nursing Facility Discharge Codes have remained
the same:
| 99315 |
Nursing facility discharge day management; 30 minutes or
less |
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99316
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Nursing facility discharge day management; more than 30
minutes |
This is the new Annual Assessment E & M Code:
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99318 Evaluation and management of a patient involving an annual
nursing facility assessment, which requires these three key components:
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History: Detailed Interval
Exam: Comprehensive
medical decision making that is of low to moderate complexity.
Counseling and/or coordination of care with other providers or agencies
are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs.
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Usually, the patient is stable, recovering, or improving.
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The Domiciliary Care Services Family (99341 - 99350) have updated
descriptors and vignettes. Revised
Code
Domiciliary Care Services are new for 2006. Click on the
link above to review them.
American Medical Association. All Rights Reserved. No fee
schedules, basic units, relative values, or related listings are
included in CPT. The AMA assumes no liability for the data contained
herein. Applicable FARS/DFARS restrictions apply to government
use.
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