99212 CPT CODE DESCRIPTION
99212 CPT Code: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components. For code 99212 CPT CODE, the office or other outpatient visit is for the evaluation and management of an established patient, and requires at least two of these three key components be present in the medical record:
- A problem focused history
- A problem focused examination;
- Straightforward medical decision making
A tip for billing 99212 is that the presenting problems are usually self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
Level 2 Established Office Visit (99212)
This is the second-lowest level of care for an established patient being seen in the office. Internists used this code for 3.1% of these encounters in 2014. Usually, the presenting problems are self-limited or minor. The Medicare allowable reimbursement for this code is $43.68 and it is worth 0.48 work RVUs.
Established Patient E/M: 2 of 3 Key Components
Office/outpatient E/M codes for an established patient, 99212-99215, require a visit to meet only 2 of the 3 key components listed to support the service level. The following table shows the key component requirements for the different established patient office/outpatient E/M code levels.
|99211||(Usually, the presenting problems are minimal)|
|99212||Problem focused||Problem focused||Straightforward|
|99213||Expanded problem focused||Expanded problem focused||Low complexity|
Coding Office Visits – Based on Time
An E/M office visit may be coded based solely on face-to-face time when more than half is devoted to counseling or coordination of care. CPT requirements for history, exam, and medical decision making requirements do not have to be met. Be sure to document the total time spent and that more than half involved counseling or coordination of care, and describe the nature of the counseling or care coordination activities (e.g., “counseled patient regarding weight gain, daily food intake, and goal setting”). Choose your level of service according to CPT’s definitions of what is typical for each code.
|CPT Code||Typical Time|
REIMBURSEMENT FOR CPT CODE 99212
|CPT Code||Service Time||Medicare||Commercial|
|99212||10 minutes||$ 40.61||$ 90.00|
|99213||15 minutes||$ 68.10||$ 90.00|
|99214||25 minutes||$ 101.21||$ 90.00|
|99215||40 minutes||$ 136.57||$ 148.00|
* It’s important to note that CPT Code 99212 reimbursement rates vary by location, the insurance company, network status, panel, license, and more.
For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com