What does procedure code 99213 mean?
Asked by: Mrs. Carolina Murphy | Last update: March 26, 2025Score: 4.7/5 (32 votes)
What is CPT code 99213 used for?
CPT Code 99213 Description:
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components to be present in the medical record: An expanded problem focused history. An expanded problem focused examination.
What is an example of a 99213 visit?
An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.
What level of visit is 99213?
This code 99213 is described as a “Level 3 Established Patient Office Visit”, which means this visit usually involves: A detailed history. A detailed physical examination. Medical decision-making of moderate complexity.
What is the difference between a 99213 and an 99214?
The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.
What is a level 3 or 2 office / outpatient visit in medical coding? 99213 & 99203 explained
What is a level 3 doctor visit?
Level-III visits are considered to have a low level of risk. Patient encounters that involve two or more self-limited problems, one stable chronic illness or an acute uncomplicated illness would qualify.
What determines the level of an office visit?
Medical decision making drives the level of office visit
The medical decision-making portion of evaluation and management guidelines is what ultimately determines the level billed. Higher complexity in decision making justifies higher levels.
Is 99213 a preventive code?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
What are the requirements for a 99214 visit?
According to CPT, 99214 is indicated for an “office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity.” [For more detailed ...
Does Medicare pay 99213?
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.
Can 99213 be billed for telehealth?
These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
What is the purpose of procedure code?
CPT® is a uniform coding system consisting of descriptive terms and identifying codes used primarily to identify medical services and procedures furnished by physicians and other health care professionals for which they bill public or private health insurance programs.
What modifier to use with 99213?
Get to know them
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Which of the following cannot be counted for time-based E&M coding?
The only time that can be included in the calculation of total time is the time personally spent by the physician or QHP on the date of the encounter. Again, ancillary staff time cannot be counted; this includes medical assistants, patient care technicians, licensed vocational nurses, licensed practical nurses, etc.
When should 99213 be billed?
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes.
Can you bill a well visit and sick visit at the same time?
In fact, it will get easier to bill a well and sick visit together if the situation arises. That's because, unless you opt for coding the sick visit by time, “the sick portion of the visit will be based strictly on MDM, and history and exam will no longer be factors in determining the level billed,” Holle notes.
What is the difference between preventive visit and office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.
What is the difference between CPT code 99213 and 99214?
An expanded problem-focused history, consistent with a 99213, requires one to three HPI elements while a detailed history consistent with a 99214 requires four or more HPI elements.
What is the difference between an appointment and an office visit?
An appointment is something you do to make something in a certain timespan now or in the future to have a possible contact with the clinic or anyone in the Clinic. A Visit is a result of an appointment and can be anything that that client has to do in the clinic for any sort of car.
What are the three questions a coder must ask themselves when selecting an E&M code?
Many E/M codes, such as those for inpatient care and home visits, include a combination of patient history, examination, and medical decision making (MDM). These factors — history, exam, and MDM (HEM) — are known as the three key components of E/M level selection.
What documentation is required for 99213?
- Relevant documentation: To support the 99213 code, include pertinent information such as the reason for the visit, history of present illness, review of systems, physical examination, assessment, and plan of care.
What is a level 5 doctor visit?
Level 5 visits (code 99205) require a high level of medical decision-making and number and complexity of problems addressed (ie, one or more chronic illnesses with severe exacerbation progression or side effects of treatment or one acute or chronic illness that poses a threat to life or bodily function), an extensive ...
How many years before a patient is considered a new patient?
Medicare has stated that a patient is a new patient if no face-to-face service was reported in the last three years.