Worksheet for 11997 Billing Guidelines for New Patients (For Established Patients Use Coding Numbers 99212-99215)

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 X X X X X X X X X X X X X X X X X X 99201 99202 99203 99204 99205

Worksheet for 1Billing Guidelines for Patient 1

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 99201 99202 99203 99204 99205

Worksheet for 1Billing Guidelines for Patient 2

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 99212 99213 99214 99215

Worksheet for 1Billing Guidelines for Patient 3

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 99212 99213 99214 99215

Worksheet for 1Billing Guidelines for Patient 4

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 99201 99202 99203 99204 99205

Worksheet for 1Billing Guidelines for Patient 5

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 99201 99202 99203 99204 99205

Worksheet for 1Billing Guidelines for Patient 6

E&M Code Patient History Brief CC/HPI: 1-3 bulleted elements Extended CC/HPI: 4 (+) HPI bulleted elements Problem Pertinent ROS: 1 system Extended ROS: 2-9 systems Complete ROS: 10 (+) systems Pertinent PFSH: At least one item from any of the three history areas directly related to the problem(s) identified in the HPI Complete PFSH: 2 or 3 elements Examination Problem Focused: A limited exam of the affected body area or organ--1-5 bulleted elements in one or more organ system or body area. Expanded Problem Focused: a limited exam of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)--at least 6 bulleted elements in one or more organ system or body area(s). Detailed: an extended examination of the affected body area(s) or organ system(s) or any other symptomatic or related body area(s)--at least six organ systems or body areas. For each, system or area documentation of at least two bulleted elements, or a total of at least 12 elements. Comprehensive: a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body areas or organ systems--Should include at least nine organ systems or body areas. Perform all bulleted elements of each system/area (<18 elements). Medical Decision Making Straightforward Minimal # of diagnosis or management options considered Minimal tests and documentation reviewed or analyzed One self-limited or minor problem Minimal risk of complications and or morbidity or mortality Low Complexity Limited # of diagnosis or management options considered Limited tests and documentation reviewed of analyzed Two or more self-limited or minor problems. One stable chronic illness. Acute uncomplicated illness or injury Low risk of complications and or morbidity or mortality Moderate Complexity Multiple of diagnosis or management options considered Moderate tests and documentation reviewed of analyzed One or more chronic illnesses with mild exacerbation or progression. Two or more stable chronic illnesses. Undiagnosed new problem Moderate risk of complications and or morbidity or mortality High Complexity Extensive # of diagnosis or management options considered Extensive tests and documentation reviewed of analyzed One or more chronic illnesses with severe exacerbation or progression. High risk of complications and or morbidity or mortality. Acute/chronic illnesses or injuries that may pose a threat to life or bodily function. Alvita Nathaniel 2004 99212 99213 99214 99215