Which code is used for a high level new patient exam?

• A. 99202
• B. 99205
• C. 99203
• D. 99204

Answer: (B)

When coding a new patient visit, the level you pick reflects how much history, how comprehensive the exam, and how complex the medical decision making is, or how much time was spent. A high level for a new patient means a very involved encounter with extensive history, a thorough and broad examination, and high complexity in decision making. That level is chosen only when the documentation supports those elements, often corresponding to the longest time requirement or the most complex MDM. The other levels describe progressively less history, exams, and decision making, so they’re used for simpler visits. So for a high level new patient exam, you select the top tier of the new patient category—the most complex, time-intensive option. If time is the driver, expect around the upper end of the allotted time for new patient visits.