Wednesday, July 7, 2010

CPT 99202 - 99205 or 99212 - 99215 - Review of system

Review of Systems: 

These are based on questions that the provider asks the patient.
At least one item must come from a specific area for that area to be included. If patient’s condition prevents them from doing a review of system (a physical or mental condition), it should be stated so and then Review of Systems will receive the necessary credit.

This generally starts with “Patient denies…” or “Patient states….”
1. Constitution – general opinion of health
2. Eyes
3. Ears, Nose, Throat, Mouth
4. Cardiovascular
5. Respiratory
6. Gastrointestinal
7. Genitourinary
8. Musculoskeletal
9. Integumentary (and/or Breasts)
10. Neurological
11. Psychiatric
12. Endocrine
13. Hematologic/Lymphatic
14. Allergic/Immunologic

Statements such as “ROS done” or All ROS negative” are inappropriate.

Coding Requirements:
               Level 99202, 99212 requires none
              Level 99203, 99213 requires at least 1
              Level 99204, 99214 requires at least 2
              Level 99205, 99215 requires at least 10
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download