2020 began with many significant billing and coding updates for family physicians. A study found that Family physicians could not bill for all the services provided in the majority of their visits because CPT codes for medical billing did not cover the services, a study found. Family practice medical billing services ensure providers do not miss opportunities to maximize reimbursements. The correct CPT coding ensures a smooth medical billing process. The CPT coding system details medical, surgical, and diagnostic services that healthcare professionals or physicians perform—family Practice CPT Codes Range.
The American Medical Association (AMA) developed and maintained the coding system, which offers healthcare providers “a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency.”
Family physicians’ most common CPT codes for medical billing are 99213 and 99214. The CPT system and CMS Evaluation & Management (E&M) rule states that 99213 can be used if a physician treats a patient for one stable chronic condition, such as stable liver cirrhosis. Below is a list of the code ranges for family practice services and procedures.
Family Practice CPT Codes
CPT Code 99213
The Current Procedural Terminology (CPT) code 99213, maintained by the American Medical Association, is a medical procedural code for Established Patient Offices or Other Outpatient Services.
The American Medical Association (AMA) Describes the 99213 CPT® Procedure Code as follows:
Office or other outpatient visits to evaluate and manage an established patient require at least two of these three components: an expanded problem-focused history, an expanded problem-focused examination, and Medical decision-making of low complexity.
Counseling and coordination of care with other providers or agencies are provided in a manner consistent with the nature of the problem(s) and the patient’s and/or family’s needs. The presenting problem(s) are usually of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.
According to the CPT book, 99213 lists a typical time of 15 minutes, while 99214 has a typical time of 25 minutes.
CPT Code 99214
The Current Procedural Terminology (CPT) code 99214, as maintained by the American Medical Association, is a medical procedural code in the range of Established Patient Offices or Other Outpatient Services.
According to CPT, 99214 is indicated for an “office or other outpatient visits 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.”
Physicians can bill a CPT code 99214 if they see a patient with one chronic disease not in optimal control. For example, the patient may have stable angina two months post-myocardial infarction, and he is not tolerating one of his medications.
Rules of Thumb for 99214
Use 99214 in any of the following situations:
- If the patient has a new complaint with a potential for significant morbidity if untreated or misdiagnosed,
- If the patient has three or more old problems,
- If the patient has a new problem that requires a prescription,
- If the patient has three stable problems that require medication refills or one stable problem and one inadequately controlled problem that requires medication refills or adjustments
MBC Can Be Your Savior in Revenue Recovery from Denied Family Practice Billing Claims
Legacy AR (Accounts Receivable) in the context of family practice CPT codes refers to collecting and managing outstanding payments from insurance providers and patients. When exploring the most common family practice CPT codes, it’s crucial to understand the connection between these codes and Legacy AR processes. Proper coding ensures accurate billing and significantly reduces aged receivables, streamlines revenue cycles, and minimizes financial discrepancies within family practices.
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FAQs
A: CPT codes are crucial because they determine how medical services are billed and reimbursed. Correct coding ensures accurate payment and reduces billing errors.
A: Common CPT codes in family practice include office visits, preventive care, immunizations, minor surgical procedures, and diagnostic tests. Examples are codes for routine check-ups, vaccinations, and superficial wound repairs.
A: Using the wrong CPT code can lead to claim denials, reimbursement delays, or incorrect billing. It may also cause compliance issues. Correct coding is crucial for smooth billing processes.
A: There are specific CPT codes for preventive care, like routine physical exams and age-appropriate screenings. These codes help ensure that preventive services are covered by insurance.
A: You can find a complete list in the CPT code manual published by the American Medical Association. Many healthcare facilities also provide staff with access to online coding resources.
