The year 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 that providers do not miss out on opportunities to maximize reimbursements. The correct CPT coding ensures a smooth medical billing process. The CPT coding system provides details about medical, surgical, and diagnostic services performed by healthcare professionals or physicians.
The coding system is developed and maintained by the American Medical Association (AMA), which offers healthcare providers “a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency.”
The most common CPT codes used by family physicians 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 cirrhosis of the liver.
CPT Code 99213
The Current Procedural Terminology (CPT) code 99213 as maintained by the American Medical Association, is a medical procedural code under the range – Established Patient Office or Other Outpatient Services.
The American Medical Association (AMA) Describes the 99213 CPT® Procedure Code as follows:
Office or other outpatient visits for the evaluation and management of an established patient, which requires at least two of these three components: An expanded problem-focused history; An expanded problem-focused examination; Medical decision making of low complexity.
Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are 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 under the range – Established Patient Office 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 physicians 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
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