Final Step: Visit level Assignment

All three weights described in steps 1-3 will be used in combination to assign the final visit level (Level 1, 2, 3, 4 or 5) to the claim using this formula:

Total Weight = Standard Cost Weight + Extended Cost Weight + Patient Complexity Cost Weight

Each visit level equates to a range of weights. The total weight is compared to these ranges and the final visit level is assigned to the claim.

Visit Levels

Visit Level Procedure Codes Explanation
199281/G0380Used for very simple and limited services. The presenting problem is usually self-limited or minor.
299282/G0381Typically assigned for an acute episodic illness and/or minor injury evaluation. The presenting problem is of low to moderate severity.
399283/G0382Generally requires additional facility resources including x-ray, laboratory testing or additional nursing time. The presenting problem is of moderate severity.
499284/G0383For encounters associated with acute illness or injury that requires prolonged evaluation and typically diagnostic studies, repeat nursing evaluations, or other therapeutic interventions. The presenting problem is high severity requiring urgent evaluation.
599285/G0384For encounters that are associated with serious presenting symptoms, often a life-threatening disease or injury, requiring treatment that is complex and/or resource intensive. The presenting problem is of high severity and/or poses an immediate significant threat to life or physiological function.