Description
CPT code 99213 refers to an evaluation and management (E/M) service provided in an office or outpatient setting for an established patient.
This code signifies a visit with low-complexity medical decision making. It typically involves one established problem (worsening or stable) and minimal to moderate risk.
Documentation for this code requires at least two of the three elements:
An expanded problem-focused history
An expanded problem-focused examination
Medical decision making of low complexity
Modifiers
You mentioned modifier 25. This modifier indicates a separate E/M service on the same date by the same physician. It's used when addressing a second, unrelated medical problem during the same visit.
Description for Different Years (2021-2023):
The core description of 99213 remains consistent across these years. However, there might be slight variations in coding guidelines or reimbursement rates set by Medicare or private insurers. Up-to-date information is crucial for accurate billing.
Time
While not the sole factor, the typical time spent on a 99213 visit is generally around 15 minutes. However, documentation and medical complexity are the primary determinants for code selection, not just time.
Medical Billing
CPT code 99213 is a crucial code used in medical billing to indicate the type of E/M service provided. It helps determine appropriate reimbursement from insurance companies.
Medicare and CMS
Medicare uses a specific system for E/M coding. CPT code 99213 falls within the established patient E/M codes used by Medicare and follows their guidelines set by the Centers for Medicare & Medicaid Services (CMS).
Examples
A patient with a known case of allergies comes in for a follow-up appointment to discuss mild symptoms and receive a prescription refill. This could be coded as 99213.
Note: Examples are for illustrative purposes only. The specific code selection depends on the details of the encounter documented by the healthcare provider.
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