What is CPT code 99213 used for?
Asked by: Mrs. Tressa Grady II | Last update: March 23, 2025Score: 4.8/5 (14 votes)
When should I use 99213?
CPT 99213 specifically describes a moderate-complexity office or outpatient visit. This code applies only to established patients—those who have previously been seen by the practitioner or another provider within the same group practice within the last three years.
What does procedure code 99213 mean?
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 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 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.
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What two factors may be considered in assigning an outpatient visit code?
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making.
Is 99213 covered by Medicare?
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.
Is 99213 a telehealth code?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via 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.
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.
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.
What is a 25 modifier used for?
Modifier 25 is appended to indicate that a significant, separately identifiable E/M service was performed by the same physician or other QHP on the same date.
What is the CPT code for outpatient visit?
Office or Other Outpatient Services CPT® Code range 99202- 99215.
What is a complex office visit?
Complex visits are defined as those with over two diagnoses (the mean of diagnoses made per visit) and/or those with over three prescription medications (the mean of medications prescribed per visit).
When can you bill 99213?
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes.
What is the 7 day telehealth rule?
The communication cannot be related to a medical visit within the previous seven days and cannot lead to medical visit within the next 24 hours (or soonest appointment available). Physician or other clinician may respond to patient by telephone, audio/video, secure text messaging, email, or patient portal.
How do I bill for a phone visit?
- Use modifier -93 for the reporting of medical services that are provided via real-time interaction between the physician or other qualified health care professional (QHP) and a patient through audio-only technology. ...
- Use the normal Place of Service, e.g. POS = 11 for private practice.
- CPT Codes.
What are three services not covered by Medicare?
We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.
Can you use 99213 for telehealth?
The face-to-face time with the physician is 22 min and the code billed is 99213 (less than the minutes currently typical for 99214 and within the 20–29 min designated for 2021). These telemedicine visits will require documentation similar to in-person visits.
What is the code for a wellness visit?
At ChartSpan, we provide eligibility checks for G0438 and G0439 — the core codes for Annual Wellness Visits.
Which diagnosis cannot be coded in the outpatient setting?
1. Should no specific diagnosis be established, and the patient presents with only signs or symptoms, the first-listed diagnosis may be the signs and symptoms. Outpatient coders cannot code “probable,” “suspected,” “likely,” or “rule out” conditions.
Can you bill an office visit and hospital visit on the same day?
CPT Codes 99221-99223, 99231-99236, 99238 & 99239
MACs pay both visits if you see a patient in the office on 1 day, and they're admitted to the hospital as an inpatient or get observation care on the next day.
What is the difference between outpatient and office visits?
The main difference between outpatient and office visits is the cost. You'll receive the same care from your doctor regardless of the facility being used, but outpatient facilities sometimes charge patients additional hospital affiliation fees.