Modifications to the CPT® Code and Guidelines
The E/M rules contain elements universal to all E/M categories and sections exclusive to their respective categories. The vast majority of service categories and many subcategories have their own rules or instructions exclusive to that category or subclass. Where they are stated, for example, “Hospital Inpatient and Observation Care,” special instructions are supplied before the listing of the individual E/M service CPT® codes. It is essential to review the guidelines for each category and subcategory carefully. These recommendations are to be utilized by the reporting physician or any other competent healthcare practitioner to identify the appropriate level of service. These recommendations do not impose any documentation requirements or standards of care. The primary goal of documenting patient care is to assist present and future healthcare team members in providing quality care to patients (s). These guidelines apply to services that require face-to-face encounters between the patient, a family member or caregiver, and an attendant.
Regarding cases 99211 and 99281, face-to-face services may be carried out by clinical professionals.)
There are a lot of different code categories to choose from under the Evaluation and Management area (99202-99499). It’s possible that each category has its own unique criteria or that the CPT® codes include particulars.