99204

The Current Procedural Terminology (CPT) code 99204 designates a specific level of evaluation and management (E/M) service for a new patient in an office or other outpatient setting. This code signifies a comprehensive history and examination, coupled with moderate complexity in medical decision-making. As an example, this code might be applied when a physician sees a new patient presenting with a complex medical history and multiple chronic conditions requiring a thorough workup and management plan.

Accurate application of this code is vital for appropriate reimbursement and compliance with coding guidelines. Correct usage ensures that healthcare providers are fairly compensated for the cognitive effort and resources expended during patient encounters. Historically, E/M coding has undergone revisions to clarify requirements and reduce ambiguity, emphasizing the importance of precise documentation to support the level of service billed.

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The alphanumeric string “99204” represents a specific category of medical service within the Current Procedural Terminology (CPT) code set. It describes an office or other outpatient visit for the evaluation and management of a new patient, requiring a medically appropriate history and/or examination and moderate level of medical decision making. Typically, counseling and/or coordination of care dominate the service; it is a visit with a total time of 45-59 minutes spent on the date of the encounter. For instance, this code might be used when a new patient presents with a complex medical history requiring detailed assessment and development of a comprehensive treatment plan.

Proper understanding and application of such codes is crucial for accurate medical billing and reimbursement. These codes ensure healthcare providers receive appropriate compensation for the services rendered, facilitating the financial stability of medical practices. Historically, the CPT code system was developed to standardize medical reporting, allowing for efficient data analysis and improved communication among healthcare professionals and payers.

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