CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes
As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. These codes, among the rest of the CPT code set, are clinically valid and updated on a regular basis to accurately reflect current clinical practice and innovation in medicine.
The clinical examples and their procedural descriptions, which reflect typical clinical situations found in the health care setting, are included in this text with many of the codes to provide practical situations for which the codes would be appropriately reported. It is important to note that these examples do not suggest limiting the use of a code instead, they are meant to represent the typical patient and service or procedure. In addition, they do not describe the universe of patients for whom the service or procedure would be appropriate.
Typical patient description
Typical patient description
Office visit for an established patient with a stable chronic illness or acute uncomplicated injury.
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
About the CPT code set
About the CPT code set
Medical knowledge and science are constantly advancing, so the CPT Editorial Panel manages an extensive process to make sure the CPT code set advances with it. The Panel obtains broad input from practicing physicians and the health care community to ensure that the CPT code set reflects the coding demands of digital health, precision medicine, augmented intelligence and other aspects of a modern health care system. This rigorous process keeps the CPT code set current with contemporary medical science and technology, so it can fulfill its vital role as the language of medicine today and the code to its future.
Disclaimer:Information provided by the AMA contained within this resource is for medical coding guidance purposes only. It does not (i) supersede or replace the AMA’s Current Procedural Terminology manual (“CPT® Manual”) or other coding authority, (ii) constitute clinical advice, (iii) address or dictate payer coverage or reimbursem*nt policy, and (iv) substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.
CPT® is a registered trademark of the American Medical Association.
Table of Contents
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes
15 minutes in length, as determined by their level of risk and complexity of treatment. If a client has a more complex treatment plan requiring additional time, bill evaluation and management CPT Code 99214 or 99215 to designating higher risk and complexity of services.
CPT Codes 99212 and 99213 may be billed for each patient during each session in accordance with the time spent, as long as the regulations for billing requirements are met.
For example, if the total duration of face-to-face physician-patient time is 21 minutes, select code 99214 because the duration of visit is closer to 25 minutes, the average time for a 99214, than it is to 15 minutes, the average time for a 99213.
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.
99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20–29 minutes of total time is spent on the date of the encounter.
99213 or 99214 Visit? Documentation of each patient encounter should include: * Reason for the encounter and relevant history,physical examination findings and prior diagnostic test results.
If the circ*mstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with a demonstration of home monitoring of a patient's international normalized ratio (e.g., HCPCS code G0248), modifier 59 would be appended to the demonstration code.
Since CPT code 99417 was created to describe a 15-minute prolonged office or other evaluation and management services (with OR without direct patient contact), CPT codes 99354 and 99358 can no longer be reported with CPT codes 99201-99215 in 2021.
This means a traditional 50-minute therapy hour should be billed as 90834; however, this also means that you should be rightfully reimbursed for longer sessions with 90837.
Introduction: My name is Merrill Bechtelar CPA, I am a clean, agreeable, glorious, magnificent, witty, enchanting, comfortable person who loves writing and wants to share my knowledge and understanding with you.
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