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:
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 Level||Procedure Codes||Explanation|
|1||99281/G0380||Used for very simple and limited services. The presenting problem is usually self-limited or minor.|
|2||99282/G0381||Typically assigned for an acute episodic illness and/or minor injury evaluation. The presenting problem is of low to moderate severity.|
|3||99283/G0382||Generally requires additional facility resources including x-ray, laboratory testing or additional nursing time. The presenting problem is of moderate severity.|
|4||99284/G0383||For 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.|
|5||99285/G0384||For 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.|