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Current Guidelines -99213/99214 2021 Guidelines -99212 based on time, 99213/99214 on MDM Medical Decision-Making Low/Moderate: Acute, uncomplicated illness or injury -99213 OR Acute illness with systemic symptoms -99214 Straightforward: No data reviewed -99212 Moderate: Prescription drug management -99214 21 Example - Has 2 day hx of L lateral ankle pain. How much more do the therapy add-on codes typically add to the encounter? My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! This includes time spent with the patient during the visit as well as time spent before and after the visit reviewing the chart, documenting the encounter, making phone calls, reviewing studies, etc. In addition to preventing misunderstandings, this gives patients a better idea of all the time we spend on them outside of the actual visit. Individual Psychophysiological Therapy Incorporating Biofeedback. However, this code is extremely popular, being the second most used among middle level billing codes. 45 minutes, Psychotherapy provided alongside evaluation and management services. Beginning January 1, 2023, the current billing and documentation rules for Outpatient E/M services will be extended to include E/M services in other settings (i.e., inpatient, consults, nursing facility, home/residence). Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, Inquire about our mental health insurance billing service, offload your mental health insurance billing, Decision making regarding treatment is moderate complexity, We charge a percentage of the allowed amount per paid claim (only paid claims). It can most commonly be achieved when a consultation with a specialist (e.g. The time also was not documented in the note, which would be required to support coding based on total time. Having an in-depth idea about the various CPT codes not only keeps you updated but you can even use them when in requirement. 90846 - Family or couples psychotherapy, without patient present. Technology: Making Todays Therapy Way More Engaging. But the definitions have changed somewhat (see CPT E/M office revisions: level of medical decision making). This visit only meets one out of three criteria, so it can't be coded as a level 4 based on MDM. Physician and Resident Communities (MD / DO). Patients with 2 problems: Document the problems, at least 4 symptom elements in the HPI (such as severity, duration, timing, and quality), at least 9 items on the mental status exam, 2 ROS categories (not necessarily psychiatric), and social history (such as spending more time with friends). 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved. You must log in or register to reply here. I realize it varies geographically, but is there a significant difference between the two situations you listed above? Any time under 16 minutes of psychotherapy should not be billed as a psychotherapy add on. Thyroid is not enlarged. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf, CPT Codes 99212 and 99213: Decide Which Code to Use for Behavioral Assessment Billing, 2022CPT Code 99214Procedure Code 99214Psychiatry code reimbursementpsychiatry codes. EXAMPLE 2. Requires all THREE Key Components (Hx,Exam,and Decision Making) Jump to first page 26 Established Patients -Think : 99212 -One stable condition 99213 -Two stable problems, OTC tx. It may also include discussing the patient's care with other health professionals or family members, calling the patient later in the day, or ordering medications, studies, procedures, or referrals, as long as those actions happen before midnight on the date of service. This service is covered by some insurance plans, but because some of the activities are not face-to-face, the clinician should check with carriers about their willingness to reimburse for this code. pHK8`Anbe2D`j2^}Wq jRMu M0064 should only be used for the briefest medication check with stable patients, Source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/cpt-primer-for-psychiatrists.pdf, Other Source: https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/business_of_practice/cpt/2018_CPT_module_revised_March_2018.pdf, e/m codesevaluation and management codesmental health billingpsych codespsych cpt codespsychiatry billingpsychiatry codespsychiatry cpt codespsychiatry reimbursement rates. I've been just randomly using 99213 (or 99212 for biweekly visits) and 99214s, because of this fear of using them "too frequently." This curriculum will teach you all you need to know about performing and documenting office-based and hospital-based psychiatry E/M services. hbbd```b``IN QD2@d).$Hb 8HVd`6'Q7@ = It cannot be used with a new patient who has no history. If you're a psychiatrist seeing a follow-up patient for 30 minutes, there is almost always a way to justify that more than half of that session was spent doing therapy. Standardized assessment tools for depressio. This chart helps better visualize the CPT codes by time. And I always find it very easy to hit a 99214 (and honestly you shouldnt need to see a 99213 in more than 20 minutesso if youre billing 99213s they should be in 20 min slots). The rest involve supportive psychotherapy. Hopefully, this will encourage psychiatrists who have fled insurance networks to return to themyou can now be assured of a robust income with an insurance-based practice, even if you choose to see many of your patients for therapy. You can see these rates vary across insurance companies. Although this would seem to be a very useful code, because reviewing data is not a face-to-face service with the patient, Medicare will not reimburse for this code and some commercial carriers have followed suit. Was level 4 risk managed? Code it as a level 4 using total time. Another question re: coding - considering joining a company that exclusively does 30 min follow-ups and 1 hr news (which is what I prefer anyway) but compensation will eventually be RVU based. However, it can also be even more easily collected through assessments that are filled out in the waiting room. Yes: One chronic, uncontrolled illness. (See E/M coding changes series.) The history and exam components are no longer used for coding purposes. This definitive guide will help you avoid under-coding and allow for more accurate billing. Subjective: 23 y/o female presents for recheck of depression, also complaining of sore throat and ankle sprain. A total of three points, earned as follows: a) One point for each unique test ordered or reviewed (panels count as one point each; you cannot count labs you order and perform in-office yourself), b) One point for reviewing note(s) from each external source, and c) One point for using an independent historian. Explanation: The total time for this visit (35 minutes) is in the range of a level 4 (3039 minutes), so a physician could code it as a level 4 using total time. 99214, the Mental Status Exam must address nine of the following eleven Mental Status elements: Speech Orientation Language Memory Thought Processes Attention . Start: Dec 1, 2022 Get Offer. Title: Alzheimer's Dementia SOAP Progress Note Example Author: Liz Lobao Created Date: 3/26/2012 1:47:43 PM . Also keep in mind that decision making does not always need to include detailed exams. The fact that one code provides for additional revenue/reimbursement makes it critically important to thoroughly understood the differences. The bar is low. It is appropriate to use an E/M code in the hospital where floor time is expressed in coordination of care with the time documented. While these two codes are within the same family, they do have different regulations for reimbursement. PERRLA. They are all part of HCPS, the Healthcare Common Procedure Coding System. (2;4222;;;;;;;;;;;;;;;;;@@@@@;@@@@@@@@@@@@@@@@@@@@@ $2(! There are no new diagnosis or medications prescribed. 99214 should be used for patients whose appointments are 25 minutes and whose treatment is considered as being of moderate complexity. In order to bill 99214, you need 2/3 of either a detailed history, detailed exam, or moderate complexity MDM. While the detailed or expanded exams are fairly commonplace, as well as easily achieved, most of the questions come in regarding the history and decision-making components. The rules, which took effect Jan. 1, are the most significant changes to E/M coding since 1997 (for more details, see Countdown to the E/M Coding Changes in the September/October 2020 issue of FPM). Additionally, dont forget to check out our Psychiatry Billing Code Cheat Sheet! Outpatient Mental Health CPT Codes: 90832 - Psychotherapy, 30 minutes ( 16-37 minutes ). examples of E/M codes across specialties An attempt was made to revise the office and other outpatient examples Not enough specialties participated CPT decided to hold off on example revisions for the new code definitions For now, examples related to these code have been deleted Nonetheless, AACAP and APA collaborated on We understand that it's important to actually be able to speak to someone about your billing. Example Psychiatric Note 99214 PDF Download. Office of Corporate Compliance - University of Chicago Medicine 99214 (Office Pt, Established) Elizabeth Smith, MD . However, these may also be carried out and documented in far less complex methods than originally anticipated. The activities covered by this code include physician visits to a work site to improve work conditions for a particular patient, visits to community-based organizations on behalf of a chronically mentally ill patient to discuss a change in living conditions, or accompaniment of a patient with a phobia in order to help desensitize the patient to a stimulus. Unlisted Psychiatric Service or Procedure. Medicare will not reimburse for this service because it is not done face-to-face with the patient, and clinicians should verify coverage by other insurers to ensure reimbursement. Tonsillitis J03.90. Understanding the conditions that must be present for billing with CPT Code 99213 is pretty straightforward. zx} bf Atorvastatin 10 mg po qd It might also be used for procedures that require some degree of explanation or justification. It will be less helpful for physicians who open the computer only when needed during the patient visit. While these two codes are within the same family, they do have different regulations for reimbursement. This includes time spent with the patient, but also time spent before the visit reviewing the chart and time after the visit documenting the visit, etc. Was level 4 data ordered/reviewed? 1037539v1 OUTPATIENT/OFFICE PSYCHIATRIC PROGRESS NOTE COUNSELING AND/OR COORDINATION OF CARE (99214 or 99215) Patient's Name: _____Date of Visit:_____ Interval . If you have not recently logged in, you will need to reset your password by using the "Forgot Your Password?" link below. The total time needed for a level 4 visit with an established patient (CPT code 99214) is 30-39 minutes. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. To avoid any pitfalls, lets take a closer look at each code and how it can be used for reimbursement. is it possible to bill 99214+ 90833 for a 20 minute visit, or is that likely cheating? I think to myself, "If this person wasn't in a course of psychotherapy, at what frequency would I bill a 99214 or have a medication follow up?". This patient may have had mild back pain for three or four years, being treated with muscle relaxants. When you refer to "counseling and motivational interviewing"- are you referring to discussions about lifestyle and compliance with meds? To hit 99215 on complexity of data you have to be reviewing at least 3 external notes each from a unique source, review results of unique tests, ordering a test, or getting collateral. TheraThink provides an affordable and incredibly easy solution. This can save valuable time in patient intake and with screening the patients and monitoring their progression, even in between appointments. They are distinct from biofeedback codes 90901 and 90911, which do not incorporate psychotherapy and do not require face-to-face time. Psychiatry codes 99212 through 99215 and 99202 through 99205 are differentiated by clients being new or established. Diabetes is stable as well, with no significant hyperglycemia or episodes of symptomatic hypoglycemia. Generally, these billing codes are differentiated by amount of time spent with the patient and severity of the presenting problem. Please click here to continue without javascript.. E&M Codes for Fun and Profit: A Story of 4 Psychiatrists, Starting Your Own Private Practice: A Business Model, Antidepressant Use in Pregnancy and the Risk of Autism, Medication Fact Book for Psychiatric Practice, Sixth Edition (2022), Using SAMe In Clinical Practice with Garrett Rossi, MD, Interpreting Assessment Discrepancies from Multiple Sources, Patients with 1 problem: Document the problem, one medical review of system (ROS) item, which can be psychiatric (eg, denies anxiety), and at least 6 items from the mental status exam. 90837 - Psychotherapy, 60 minutes ( 53 minutes and over). 99204 45-59 minutes 99214 30-39 minutes 99205 60-74 minutes 99215 40-54 minutes A new prolonged service code (99417) was created for use when . This has especially been the case since changes were made back in 2013, along with the Affordable Care Acts inclusion of mental healthcare in 2006. Objective: T 100.2, P 96, R 18, BP 110/70. C%z&fbS)6+6FiSmP? Many EHRs have time calculators that will show the amount of time you have had the patient's chart open. If youre not changing anything Im willing to bet the vast majority of our patients have 3 or more problems. The Psychiatry E/M Coding Curriculum. PHQ-9) may also be used to gather more detailed information. To make this simpler, let's substitute level 4 for the term moderate as we take a look at what qualifies in each category (problems, data, and risk). Many medical professionals can bill with CPT Codes 99213 and 96214. No cervical adenopathy. Medicare reimburses for procedure code 99214 at $141.78. Severe and profound intellectual disabilities (ICD-10-CM codes F72, F73, and F79) are never covered for psychotherapy services or psychoanalysis (CPT codes 90832-90840, 90845-90849 and 90853). Behavioral health assessments can be very important tools in the most common of healthcare environments. 45-74 minutes, evaluation and management services, 75-104 minutes, evaluation and management services, +90840 Add-on code for an additional 30 minutes (, 90833 Evaluation and Management with 30 Minutes Psychotherapy, 90836 Evaluation and Management with 45 Minutes Psychotherapy, 90838 Evaluation and Management with 60 Minutes Psychotherapy. Denny and his team are responsive, incredibly easy to work with, and know their stuff. There are quite a few medical billing CPT codes for Psychiatry services and psychiatrists to use, some reimbursed more often or at higher rates than others. I would consider motivational interviewing for a SUD patient to be billable for psychotherapy, no? Assessment, For a detailed breakdown of this note with tips and advicesee99214 E/M Insight, An established office patient with hypertension, diabetes and a history of dyslipidemia, Repeat renal profile, spot microalbumin/creatinine at next visit, along with cbc, Check LFTs at next visit as well due to ongoing statin therapy, Continue lifestyle modifications and exercise for weight loss. endstream endobj 206 0 obj <> endobj 207 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 208 0 obj <>stream 205 0 obj <> endobj Preparation of Report of Patients Psychiatric Status, History, Treatment, or Progress (Other Than for Legal or Consultative Purposes) for Other Physicians, Agencies, or Insurance Carriers. hb```#ea "@Ui@@3FFlU1{,LnM"6p00Ufivp{V  Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). But then you cant bill a therapy add on code, I have always been told the MDM is implied as the driving factor. Codes 90832-90834 represent insight oriented, behavior modifying, supportive, Medical decision making is still made up of three elements: problems, data, and risk. 90792 Psychiatric Diagnostic Eval 99204 Level 4 New Patient Office Visit (Typical time 45 minutes) 99205 Level 5 New Patient Office Visit (Typical time 60 minutes) Follow-up Psychiatry appointments. This is not an exhaustive look into which E/M codes to use; please refer to our documentation and guidelines section later in this article. For example, primary care physicians, OB . Due to some of their similarities, many healthcare providers can experience confusion when deciding which one to bill. Reimbursement seems similar to 2x99214 actually. Physical Exam See the table for time length for all E/M visits. You are using an out of date browser. Any y'all still getting those letters from a certain 3rd party company the insurance companies have outsourced to for review billing numbers? This is not a comprehensive list of CPT codes. Personal belief: If you spent the time, effort and money to go through psychiatry residency +/- fellowship, you should be able to decide if you're doing "16+ minutes of psychotherapy" - not the insurance company. Nicotine use disorder, MDD, GAD, bam. Two out of three criteria were met, so code it as a level 4. To meet the criteria of a 99214 code / service, a medical service must meed the following requirements: This procedure is covered by most insurance plans. Now let's look at three examples of level 4 office visits, documented with the usual SOAP (subjective, objective, assessment, and plan) note. (Note: these changes apply only to regular office visits and not to nursing home or hospital E/M visits.). As private practitioners, our clinical work alone is full-time. But all practices are different, and some coding variation is normal. If youre changing a med, they should be a 99214 if you can pull out one more problem you can consider. I actually think its hard to have history consistently be the item because its not always necessary to have an ROS or to have PSFH in progress notes. Note: the code selection rules and documentation for outpatient services (99202-99215) have not changed. However, here's the breakdown for coding the visit based on MDM: Was there a level 4 problem? for a 99214, while the history and physical criteria are the same as for a 99215. Did you prescribe a medication and either interpret an x-ray (or ECG) or order/review three tests? It really is not that hard to have 3 chronic problems. But because the physician has documented that the visit met the criteria for a level 4 based on total time, it can be coded as a level 4. Author disclosure: no relevant financial affiliations disclosed. / I cannot capture in words the value to me of TheraThink. For more information on other ways to bill and increase your practices revenue, check out our articles on CPT Code 96127 and CPT Code 96103: CPT Code 96127 Answers to the frequently asked questions about billing this code, 3 Online Screenings That Can Be Billed with CPT Code 96127, CPT Code 96127 How to Increase Revenue with This New Behavioral or Emotional Assessment, CPT Code 96103: How to Increase Revenue and Bill with Psychological Testing, http://thehappyhospitalist.blogspot.com/2013/09/99214-CPT-Procedure-Code-Description-Examples-RVU-Distribution.html, https://www.cgsmedicare.com/partb/mr/pdf/99214.pdf, http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/Coding-Documentation-for-Behavioral-Health-2016-Zucker.pdf?ver=2016-06-01-182611-063, http://www.mdedge.com/jfponline/article/63368/practice-management/10-billing-coding-tips-boost-your-reimbursement, https://www.cgsmedicare.com/partb/mr/pdf/99213.pdf, http://www.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Clinical_Practice_Compliance_Conference/2010/Sun/P3_BrembyFriedelPPT-PDF.pdf, https://emuniversity.com/Level3EstablishedOfficePatient.html, http://www.medicarepaymentandreimbursement.com/p/medicare-fee-schedule-for-office-visit.html. Both the history and physical are required. ABDOMEN: soft, nontender, moderate L CVA tenderness. If I'm ordering and interpreting those results same day then boom, I met 99215 criteria for CoD even without reviewing outside notes. HVKo6+s5MR%S4&q*Z!u:[Y;D>y7Y~jo Subjective: 47 y/o male presents for a BP recheck. Psychiatrists are often called upon to prepare reports about the patient for many participants in the healthcare system. endstream endobj startxref It can be used to bill for an in-office visit or in an outpatient setting. Subjective: 44 yo female presents with 3 day hx of dysuria, frequency, urgency, L mid back pain, fever, chills, and nausea. Group 1 Codes. A good example of this is the utilization of mental health assessment tools to investigate the possibility of mental illness as a possible attributing factor to a health problem. This will help you bill more frequently for code 99214. %PDF-1.6 % Copyright - Mentegram, Inc, Austin TX, (512) 593-5835. At that point you are an -entire- patient behind. &k%9=[bYF?g7CHx\V;5D Sertraline 50 mg refilled. Was level 4 risk managed? In general, doctors with more elderly patients usually have a higher percentage of level 4 visits. I don't think that the reviewing 3 external notes is a requirement to hit 99215 in CoD if you're meeting 2 of the other criteria (NEEDING collateral, ordering unique tests, interpreting unique tests). hbbd``b` $k@t 2Hp w n"$@``&@BH,.f`bd)'` I don't see a reason to use an E&M code for a visit that included no E&M. Assessment/Plan: Pyelonephritis N12. EXTREMITIES no edema. PHARYNX: tonsils 2+ red s exudate. Please review the Medicare guidelines for E/M guidelines and documentation for exhaustive detail: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf. dT:a=qrn1gf E4{$. It cannot be used with a new patient who has no history. Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your the APA website for coding and reimbursement, Procedure Coding Handbook for Psychiatrists, 4th Edition, Treating Alcohol Use DisorderA Fact Book (2023). Why does frequency of visit mean these questions don't need to be asked? -O^eT!3n_D&` (f}&X4YsXTr531)A/:+/,_@Bx E/M Services Guide: Coding by Key Components (summary chart). I've been in practice since 2019. Ask us how you can start billing with CPT Codes 99213 and 99214, as well as with other codes today! Copyright 2023 American Academy of Family Physicians. Thank you. 217 0 obj <>/Filter/FlateDecode/ID[<61859C512EEFB34DB4EBBC37B36F516E>]/Index[205 20]/Info 204 0 R/Length 81/Prev 713670/Root 206 0 R/Size 225/Type/XRef/W[1 3 1]>>stream However, here's the breakdown for MDM: Was there a level 4 problem? History is rarely one of the 2 elements for me for 99214. if you have a patient with 3 or more stable problems or 1 stable problem and 1 worsening problem that is enough for moderate complexity MDM. "nPYXuD^00-ac; R!1T!C25IG?h1H5,4aUt'l^h295.HpTB yD1t#NS|BiOCc'@$.|Il1c@)pYV H|JAPy18u%@$k\8*U|QeSMcJ,'aH,.~MBib;\WP( Documentation of total time is fairly straightforward: just note how much time you spent on the visit that day. It's our goal to ensure you simply don't have to spend unncessary time on your billing. The notes/collateral/tests thing is definitely an 'or', but you have to do at least three total things from those categories. There must be two out of three of the following components: Any mix of these three components will enable a provider to bill with CPT Code 99213. Also, what do you do with people who are, say, six minutes late to their appointment? [PDF] [PDF] How To Document a 99214 E/M Code Office - ICANotes 99214 is the code for an established outpatient who is having a follow-up, including a medication For example, the statement, "Mr Jones is worse today" supports moderate complexity In the mental health field it may be difficult to identify, The presence of social determinants of health (lack of money, food, or housing) that significantly limit a patient's diagnosis or treatment. Push fluids. NAD. ADHD, ODD, other specified anxiety disorder. Glyburide 10 mg po bid For example, if the total duration of face-to-face physician-patient time is 21 minutes, select code 99214 because the duration of visit is closer to 25 minutes, the average time for a 99214,. e !1AQ"Taq2BS34CDR I have better things to do, like take care of my patients.. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. LUNGS: Clear. 99214: $375.00: Established Patient 40 minutes: 99215: $450.00: New Patient Level IV Complexity: 99204: $480.00: New Patient Level V Complexity: 99205: $615.00: Psychotherapy: 30 Minute Psychotherapy Add-on: . Dyslipidemia remains well controlled on statin therapy. ), Comparing your coding with national averages is a good way to gauge where you stand in terms of getting the reimbursements you deserve. Total time does not include time spent performing separately billed procedures or time spent by your nurse or other office staff caring for the patient. TheraThink.com 2023. HEART: S1 and S2 no murmurs. These are the basic parameters for coding a level 4 visit based on total time or MDM under the new rules. Im 98% 99214, 2% 99215. EYES: Fundi benign. I try to be extremely literal about this question. No hx of resistant infections. TheraThink.com 2023. Standardized assessment tools for depression (e.g. Elements of Medical Decision Making with Psychiatric Specific Examples Number and Complexity of Problems Amount and/or Complexity of Data to be Reviewed and Analyzed Risk of Complications and/or "Tl){yq"M%}oR{x Watches his wt and exercises. sodium amobarbital (Amytal) interview). Neurologic - Negative for paresthesias RY CC 13-year-old male seen for follow up visit for mood and behavior . The physician may choose to prescribe a medication for the patients behavioral health ailment. Other CPT code severity requirements are listed below: 99212: straightforward 99213: low 99214: moderate 99215: high ( Source) ( Source) This has especially been the case since changes were made back in 2013, along with the Affordable Care Acts inclusion of mental healthcare in 2006. The Evolution of Therapy: 3 Big Changes That Are Implementing Better Mental BCBS to Reimburse LICSWs for Screening and Assessments, 7 Things a Person With a Mental Illness Doesnt Want to Hear, Medical decision-making with low complexity, Medical decision-making that can be considered to be of moderate complexity. CPT Code 99214 can only be used for an established patient's office visit, and it is a level four code. Dont worry if you havent done an exam, as long as the appointment is 25 minutes and youve completed the other two elements! 2uZL XY!LcL6g!xR \P)P`=|67YFNO` t L Narcosynthesis for Psychiatric Diagnostic and Therapeutic Purposes (e.g. Evaluation and management of an established patient in an office or outpatient location for 25 minutes. One acute complicated injury (e.g., concussion). In more severe cases, perhaps even a referral may be set in motion for a mental health professional. A: In all likelihood the insurer is correct in suggesting that 99214 is too high a level for a patient who is stable, even though the patient has complex physical and psychiatric symptoms that are being kept in abeyance by the ongoing care you (and his other physicians) are providing. Revised Prolonged Services code 99417, new 99418, deleted codes 99354-99355, 99356- 99357. 668 0 obj <>stream %PDF-1.5 % There are so many different therapy modalities out thereI think we're just shooting ourselves in the foot if we try and overanalyze whether or not something is "actually therapy" and undercode as a result. You must have JavaScript enabled to enjoy a limited number of articles over the next 30 days. This is due, in part, to more easily achieved factors for reimbursement on this code than with other CPT Codes, including 99214. Denies other symptoms. By using the three questions presented in this article, as well as the patient examples, you should be able to more confidently code level 4 visits and make sure you're getting paid for the amount of work you're doing. CPT Code 99214 is a level four code that can be used only for an established patient, whether the visit is conducted in the office or in an outpatient atmosphere. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Once you know the ins and outs of both codes, choosing which one to bill is actually quite simple.