CPT Code 99213

Understanding CPT Code 99213: A Guide to Evaluation and Management Services

In the intricate world of medical billing, CPT codes play a vital role in accurately representing the services provided by healthcare professionals. For outpatient visits to physicians, including those specializing in nephrology, cardiology. Your family doctor may also make use of the CPT code 99213 on a regular basis. In this helpful manual from ICON Billing, you can gain a better understanding of this code. It offers insights into its purpose, the situations in which it’s used, and how it influences your medical billing.

CPT: The Language of Medical Billing

The American Medical Association (AMA) has put in place a standardized categorization system for medical services and procedures called the Current Procedural Terminology (CPT) codes. These codes ensure clear communication between healthcare providers, insurance companies, and billing specialists. CPT code 99213 falls under the category of “Evaluation and Management (E/M)” services, which encompass office visits and outpatient consultations.

Decoding CPT Code 99213: Evaluation and Management for Established Patients

More specifically, CPT code 99213 signifies an office or other outpatient visit to evaluate and manage an established patient. An “established patient” refers to someone who has already received care from the healthcare provider within the past three years.

Critical Components for Using CPT Code 99213

There are three essential components that healthcare providers consider when assigning CPT code 99213:

  • History: An extensive medical history is typically acquired during a code 99213 appointment, usually centered on addressing a particular issue. The provider gathers detailed information about the patient’s current concerns and relevant medical history.
  • Examination: The extent of the physical examination performed. For a code 99213 visit, the examination is usually an expanded problem-focused examination. It focuses on the specific body area or condition causing the patient’s concern.
  • Medical Decision Making: The complexity of the medical decision-making process involved in the visit. A code 99213 visit typically involves low-complexity medical decision-making. The provider should consider limited treatment options based on a straightforward diagnosis.

When is CPT Code 99213 Used?

Here are some scenarios where a healthcare provider might use CPT code 99213:

  • Follow-up visits: An established patient returns to discuss a previously diagnosed condition, monitor treatment progress, or address new but related symptoms.
  • Acute illness evaluations: An established patient presents with a new, non-emergency medical concern requiring evaluation and potential treatment initiation.
  • Chronic disease management: An established patient with a chronic condition like diabetes or hypertension visits for routine monitoring, medication adjustments, or management plan discussions.

CPT Code 99213 and Medical Billing with ICON Billing

Understanding CPT codes like 99213 gives patients a clearer picture of the services rendered during their healthcare visits. At ICON Billing, we leverage our expertise in medical billing to ensure accurate coding based on the complexity of the E/M service provided. We handle:

  • Accurate CPT Code Assignment: Our team stays up-to-date on coding guidelines to ensure CPT code is assigned correctly based on the details of your visit.
  • Clear and Comprehensive Documentation Review: We work closely with healthcare providers to ensure their documentation accurately reflects the level of service provided, supporting the use of this CPT code  when applicable.
  • Streamlined Insurance Reimbursement: We handle insurance claim submissions and follow-up, maximizing reimbursement for the services billed under CPT code 99213.

Beyond CPT Code 99213: Additional E/M Levels

While CPT code  represents a standard level of E/M service, there are other codes depending on the complexity of the visit. These include:

  • 99214: This represents an E/M visit with a more detailed history, examination, and medical decision-making compared to 99213.
  • 99215: Represents an even higher level of E/M service complexity with a comprehensive history, examination, and medical decision-making.

Conclusion: Demystifying Medical Billing with Confidence

Understanding CPT codes like 99213 empowers you to navigate medical billing better. When you team up with ICON Billing, you can trust that your medical practitioner is submitting precisely-coded services. Leading to an increase in insurance payments and a decrease in unexpected bills.Let us handle the complexities of medical billing so you can focus on your health and well-being.

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