For a NEW condition/illness/injury in an established patient, which CPT code applies?

• A. 99212
• B. 99202
• C. 99214
• D. 99203

Answer: (C)

When coding an office visit, who the patient is to the provider (new vs established) sets the general category, but the level of code is driven by history, exam, and medical decision making (MDM). For an established patient who presents with a new condition, you don’t switch to a new-patient code—you stay in the established-patient category and choose the level that matches the documentation.

In this scenario, the encounter would typically require a detailed history, a detailed physical examination, and medical decision making of moderate complexity. That combination maps to an established-patient level 4 visit. It reflects the added depth needed to evaluate and manage a new problem in someone with an existing doctor-patient relationship. If the visit were simpler, a lower level would be appropriate; if it were more complex, a higher level could apply.