First Visit for a Chronic Condition

Question:

I am seeing a patient for the first time in the office and they are reporting to me that they have had psoriasis for over two years and their symptoms are worsening; is this problem a level 3 (99203) or 4 (99204)?

Answer:

If your documentation indicates the patient has a chronic condition that is worsening, then the complexity of the problem addressed is moderate, even if this is their first visit to you. However, keep in mind there are three elements to Medical Decision Making:

• Complexity of Problem(s) Addressed

• Amount and/or Complexity of Data to be Reviewed or Analyzed

• Risk of Mortality and/or Morbidity of Patient Management

Two of the three elements on the risk table must be met.  For example, if the condition managed is chronic psoriasis worsening and you write a prescription for a topical medication, the complexity of the problem addressed is moderate with moderate risk. This would indicate a level four new patient visit (99204).

*This response is based on the best information available as of 4/10/25.