New Condition/illness/injury of an established patient corresponds to which CPT code?

• A. 99212
• B. 99214
• C. 99203
• D. 99204

Answer: (B)

In CPT E/M coding, when an established patient returns with a new condition or problem, you use established-patient codes (not new-patient codes), and the level you pick depends on how much history you collect, how thoroughly you examine, and how complex your medical decision making is. A new problem in an established patient typically requires more documentation and a more detailed assessment, which often places you at the mid-to-upper end of established visits. The level four established visit reflects expanded or detailed history and exam with moderate medical decision making, matching the scenario of a new condition in an established patient. Lower levels would fit less complex follow-ups, while higher levels would be used if the history, exam, or MDM were more extensive.