For billing code 99205, what type of exam is required?

Billing code 99205 is used for new patients in an office or other outpatient setting. This specific code necessitates a comprehensive examination. A comprehensive exam is one that must cover multiple organ systems and provide an extensive evaluation of the patient's overall health status. It is distinct because it typically involves a thorough review of systems and a detailed medical history, enabling the provider to assess complex issues or a wide range of potential conditions that might not be captured in less thorough examinations.

For code 99205, a comprehensive exam aligns with the higher level of complexity and provider effort involved in the assessment of a new patient, particularly when there are multiple problems or a heightened level of care needed. This rigorous documentation and evaluation justify the higher reimbursement level associated with this billing code.

In contrast, options such as the expanded, detailed, or problem-focused exams would not satisfy the requirements for 99205 as they do not encompass the breadth and depth demanded for a comprehensive assessment in a new patient visit. Thus, the classification of the examination as comprehensive is crucial in correctly assigning this code for billing purposes.