Understanding CPT Code 99213: Use, and Billing Principles

Medical billing is a highly complex process. It is not easy for many doctors, business professionals, and learners. CPT codes are crucial to billing and getting reimbursed precisely. There are so many codes, but one of the most common ones is CPT code 99213. However, these codes play a vital role in everyday medical practice. It means that when you pay for a particular service, only healthcare providers are paid appropriately.

Without understanding this CPT code, numerous errors in billing are going to occur. It might mean delays in your payments and, at worst, cause a denial of your claim. Therefore, in this blog, we will find information regarding the 99213 CPT. You will learn when and how you should apply these billing guidelines in the right way. We want it to be as easy to understand as possible. Whether you are coming fresh to medical billing or you want to remember what you have forgotten, this guide is for you. Let’s take a look at CPT code 99213 together.

What are CPT Codes?

CPT code refers to the Current Procedural Terminology (CPT) Disease. Healthcare providers use these codes to describe medical services and procedures. The American Medical Association oversees the CPT codes to make sure the medical fraternity uses the exact wording. It generalizes what doctors do to ensure that everyone, from doctors and insurance companies to the patient, knows what the services are. For instance, if a doctor gives someone a routine checkup, they will forward their bill to the patient using a specific CPT code for that visit. CPT codes are very important to accurate billing and payment. If they didn’t exist, it would be confusing sometimes and would take more time to be paid. Understanding CPT codes makes our work get the billing process simple.

Why are CPT Codes Important?

Telemedicine app development company provide CPT codes to follow standardized language that healthcare providers, patients, and payers (such as insurance companies) can use. It will ensure clear communication. CPT codes are employed for billing purposes. Proper coding will allow reimbursement for services provided. It also helps in data collection in healthcare services, which are the basis of any policy and research.

When to Use CPT Code 99213

1. Appropriate Situations

CPT code 99213 is appropriate when the patient has a visit that includes:

• Minor to Moderately Serious Problems: Stable or improving stable needs to be followed.
• Chronic Condition Follow-ups: Follow-ups for conditions such as hypertension, diabetes, or asthma.
• Medication Management: Titration of doses or side effects of medications.
• Reviewing Test Results: Follow-up on lab tests or imaging that need interpretation.
• Addressing New Symptoms: Minimal new symptoms that may not necessitate significant workup.

2. Examples of Visits

• Hypertension Management: A patient whose blood pressure is controlled comes in for a follow-up
• Diabetes Follow-up: A patient whose blood glucose is being monitored comes in with their blood glucose logs and discusses them with the physician. The physician adjusts their insulin based on the results.
• Asthma Monitoring: A patient with asthma reports an occasional wheeze, and the physician checks her inhaler technique.
• Medication Side Effects: If a patient develops minimal side effects from a new medication, the physician adjusts the medication.

3. Inappropriate Use

Do not use CPT Medical code 99213 for:

• Minimum Visits: Use 99211 instead.
• Complex Visits: If the visit involves critical examination and significant complexity decision-making, use 99214 or 99215.
• New Patients: For new patients, use codes 99201-99205.

Decomposing the Elements of CPT Code 99213

To properly use CPT code 99213, you must be familiar with its three components: History, Examination, and Medical Decision Making. Of these three elements, at least two must be eligible to use this code.

1. History

Extended Problem-Focused History

This type of history includes:

• Chief Complaint (CC): The main reason for the patient’s visit.
• History of Present Illness (HPI): A brief description of the symptom or issue (1-3 words).
• Review of Systems (ROS): A problem-specific review directly related to the presenting issue.
• Past, Family, and Social History (PFSH): Included only if relevant to the problem.

Example:

• CC: “Follow-up on hypertension.”
• HPI: Occasional headaches at home; blood pressure recorded as 130/85.
• ROS: Afebrile, no chest pain, dizziness, or shortness of breath reported.

2. Oriented History

Enlarged Problem-Oriented History

This type of history includes a detailed evaluation of the following medical billing and coding:

• Focused History: Assessment of the affected area or organ system, along with related systems (covering at least 2-7 systems or areas).
• Vital Signs: These include blood pressure, heart rate, and respiratory rate.
• Cardiovascular Exam: Normal heart sounds; no murmurs detected.
• Respiratory Exam: Lungs clear upon auscultation.

3. Medical Decision-Making

Low Complexity

This level of medical decision-making involves:

• Number of Diagnoses or Management Options: Few, typically one stable chronic condition.
• Quantity and Complexity of Data Assessed: Limited data, such as evaluating basic lab studies.
• Risk of Complications: Low risk for the patient’s condition or treatment plan.

Example:

• Adjusting an antihypertensive dosage.
• Ordering routine laboratory tests.

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