The Most Overlooked 2018 CPT Codes
STAY UPDATED WITH CPT CODES
CPT Code Updates are issued annually and periodically as necessary. Knowledge and the correct application of 2018’s Updated CPT Codes are essential for medical providers, to ensure maximum payment and reimbursement rates.
CPT Codes 99213 and 99214
CPT Codes 99213 and 99214 belong to the same billing family or bundle. All these procedures are performed in the provider’s facility, either as a standard office visit, and/or any, or other outpatient procedure.
Because of the naming protocol used in CPT, numerous procedures, are too similarly named or derived, causing apotential risk, in this case, a raised probability of miscoding of procedures.
Office Visit and Outpatient Services
CPT: 99213
Description: Office or other outpatient visit for the E&M of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity.
National Pmt Amount: $74.16
CPT: 99214
Description: Office or other outpatient visit for the E&M of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity.
National Pmt Amount: $109.44
CPT Codes 99495 and 99496
CPT Codes #99495 and 99496 share procedures and endorsements that are all related by the same bill bundle just like codes 99213 and 99214, that the subtle difference in the procedure descriptions eventually leads to overlooking the rate difference.
Just like the outpatient care codes, there is a significant rate difference between a regular office visit and a procedure coded and billed as a transitional care codes.
Transitional Care Codes
CPT: 99495
Description: Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge.
National Pmt Amount: $167.04
CPT: 99495
Description: Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge.
National Pmt Amount: $236.52
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