99213 CPT Code Description: What It Means & When to Use It

In the health world of billing, accurate coding should be performed for payment and documentation. The commonly used CPT code is 99213, which refers to an office or other outpatient visit for evaluating and managing an existing patient. Thus, this article will discuss the 99213 CPT Code description, including its components, application, and execution in daily clinical practice.

What is the 99213 CPT Code?

CPT code 99213 is an E/M for office or other outpatient visits with established patients. This one describes a moderate level of care complexity, including provision by a general healthcare professional like a physician, nurse practitioner, or physician assistant. This is usually during follow-up visits, when the patient’s condition is stable but where management or adjustment may be required.

Parts of the 99213 CPT Code

The 99213 code has features that must be fulfilled to bill and code effectively. The American Medical Association (AMA) has some stipulations regarding the E/M codes, and for the 99213, they fall in the subset that calls for a moderate degree of work on patient examination. There are three sub-parts:

• History
• Examination
• Medical Decision Making (MDM)

Let us elaborate on each step.

1. History

For a 99213 visit, the history component must be moderate. This would include reviewing the patient’s medical history, including a detailed history of present illness (HPI), a review of systems (ROS), and past medical, family, and social history. In a 99213 visit, the patient’s condition is usually stable, so the history is not as detailed as it might be for a more complicated visit.
Key parts of history:

HPI (History of Present Illness): The doctor will talk to the patient regarding symptoms, improvement, or issues.

ROS (Review of Systems): General overview of the patient’s body systems to determine other problems

PFSH (Past, Family, and Social History): A more pointed assessment than other higher-level visits.

2. Examination

For a 99213 visit, the history component must be moderate. This would include reviewing the patient’s medical history, including a detailed history of present illness (HPI), a review of systems (ROS), and past medical, family, and social history. In a 99213 visit, the patient’s condition is usually stable, so the history is not as detailed as it might be for a more complicated visit.
Key parts of history:

For instance, when a patient is coming for follow-up for hypertension, the provider might emphasize examining the cardiovascular system, and less attention may be given to other systems unless the patient presents with different concerns.

3. Medical Decision Making (MDM)

MDM may be the most important determinant of the correct CPT code for an office visit. Moderate complexity is required to support a 99213 code. This includes assessment of the patient’s medical issues and decision-making regarding further management, referrals, or tests.

The key elements of MDM are

• The number and complexity of problems worked up during the visit. For 99213, these should be moderate in severity, meaning that the conditions are stable or improving but may require adjustments in treatment.
• Amount and complexity of data reviewed (such as lab results, diagnostic imaging, or medical records). The physician will review some test results or order additional tests if necessary.
• Risk of complications and morbidity: Moderate complexity level conditions have some risk, e.g., a chronic illness that needs routine management.

When to Apply 99213 CPT Code

The 99213 CPT code is utilized for established patients with a medium complexity level. Some of the common scenarios to apply a 99213 include:

• Chronic disease management: For follow-up visits to manage stable conditions, such as hypertension, diabetes, or asthma.
• Medication management: The physician reviews and adjusts medications based on the patient’s response and condition.
• Routine check-ups: For stable patients coming in for regular monitoring, where minor adjustments or re-evaluations are needed.

Time and 99213 Code

While the CPT code 99213 focuses more on the complexity of the evaluation and management of a patient, sometimes it may depend upon the time taken with the patient to select which code ought to be utilized. Normally, the time range with the patient is about 15-30 minutes; however, that could be different for more complex cases.

Time is only considered a deciding factor if more than 50% of the visit is spent on counselling or coordination of care and if the provider documents this appropriately.

Common Errors in 99213 Coding

The most common mistake in coding 99213 is over- or underestimating the complexity of the visit. For example:

• Over-coding: If the visit is not moderate in complexity but is billed as a 99213, the physician risks over-coding. This can lead to denied claims or even audits.
• Under-coding: On the other hand, under-coding a visit can also be detrimental because the physician might not be reimbursed appropriately for the care provided.

Documentation for 99213

Accurate documentation is critical for substantiating the use of the 99213 CPT code. Healthcare providers should document:

• Purpose of visit and patient complaints or current conditions.
• History was obtained, including any new patient symptoms or developments in medical status.
• Focused physical exam with relevant findings for the patient’s ongoing issues.
• Decisions are made regarding additional testing, treatment changes, or follow-up care based on the patient’s status.

How Hello MDs Streamline the 99213 CPT Code Process

Hello MD simplifies using a 99213 CPT code by providing virtual consultations with patients and healthcare providers to ensure that the required elements to code a patient’s encounter accurately are documented completely and readily available. Hello MDs provides a telemedicine platform that allows providers to collect patient information, conduct focused assessments, and derive appropriate decisions for the treatment or management of care while meeting the criteria for the 99213 code. It also supports EHR integration without augmenting administrative burden and improving coding accuracy, ensuring full reimbursement of services for providers.

Conclusion

Regarding tools available for health billing, the most useful in everyday use would be the CPT code of 99213 for moderate-level E/M, done for an established patient. Thus, there will have to be a clear understanding of each component’s history, examination, and medical decision-making, with knowledge of applying each accurately for every care case of patients, such as managing chronic diseases or altering medicines for follow-up visits. These will include keeping proper records, tracking patients, and thus meeting the coding compliance requirement to ensure that they have been implemented. Hello, MDs will implement telemedicine as a means to enable these activities. This helps the providers with optimum coding practice that supports their records, ensuring adequate reimbursement and relief from administrative workloads for health professionals.