For family physicians, 2020 started with a slew of significant billing and coding changes. According to a study, family physicians could not bill for all of the services offered in most of their visits because CPT codes for medical billing did not cover the services.
Medical billing services for family practices guarantee that suppliers do not miss out on the opportunity to maximize reimbursements. A seamless medical billing process is ensured by correct CPT coding. The CPT coding system specifies medical, surgical, and diagnostic services provided by health care professionals or doctors.
The American Medical Association (AMA) created and maintains the coding system, which provides healthcare providers with “a uniform procedure for coding medical services that simplifies reporting and enhances efficiency and accuracy.”
Family physicians’ most commonly used CPT codes for medical billing are 99213 and 99214. According to the CPT system and the CMS Evaluation & Management (E&M) rule, 99213 can be used when a doctor treats a patient for one steady chronic condition, such as secure liver cirrhosis.
CPT Code 99213
The American Medical Association maintains the Current Procedural Terminology (CPT) code 99213, a medical procedural code in the spectrum – Of established Patient Office or Other Outpatient Services.
The American Medical Association (AMA) defines the 99213 CPT® Procedure Code as follows:
Office or other outpatient visits for the evaluation and management of an established patient require at least two of the following three factors: An extending problem-focused history; an expanded problem-focused evaluation; and limited medical decision making.
Counseling and care coordination with other suppliers or agencies are offered under the nature of the issue(s) and the needs of the patient and family. The presenting problem(s) are usually of minor to moderate severity. Generally, physicians spend 15 minutes with the patient and family
The CPT book lists 99213 as having a typical time of 15 minutes, while 99214 has a specific time of 25 minutes.
CPT Code 99214
The American Medical Association’s Current Procedural Terminology (CPT) code 99214 is a medical procedural code in the range – Of established Patient Office or Other Outpatient Services.
CPT code 99214 is assigned to “office or other outpatient visits for evaluating and managing an established patient, requiring at least two of these three main elements: a detailed history, a thorough analysis, and medical decision-making of varying capabilities.”
If a doctor sees a patient with one chronic disease that is not under optimal control, they can bill a CPT code 99214. For instance, the patient may have stable angina two months after a myocardial injury and cannot tolerate one of his medications.
99214 general guidelines
In any of the following circumstances, use 99214:
- If the patient has a new complaint that, if left untreated or mistaken, has the potential for substantial mortality rates.
- If the patient has three or more previous issues.
- If the patient develops a new problem that necessitates a prescription.
- If the patient has three stable issues that necessitate medication refills, or one steady problem and one poorly controlled problem that requires medication refills or modifications.
About Us
Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers, and Coders, including resources about HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials, and Rejections. If you want to learn more about billing and coding, Cpt codes, and modifiers, please contact us at rcmexpertz@gmail.com.
Learn More
Guidelines for Chemotherapy Administration Coding