Quick Answer: What Does CPT Code 99204 Mean?

What is the difference between CPT code 99212 and 99213?

For established patient visits (99211-99215), two of the three key components must meet or exceed criteria to qualify for a specific level of evaluation and management (E/M) services….BREAKING DOWN THE REQUIREMENTS.Coding 99212 vs.

9921319921299213HISTORYProblem-focusedExpanded problem-focused11 more rows.

What is a Level 4 patient?

CPT defines a 99214 or level-IV established patient visit as one involving a detailed history, detailed examination and medical decision making of moderate complexity. … This means that the coding can be based on the extent of the history and medical decision making only.

What is the difference between a Level 3 and Level 4 office visit?

According to Medicare’s Documentation Guidelines for Evaluation and Management Services, a level-3 established patient office visit requires medical decision making of low complexity. Moderate-complexity decision making is required for a level-4 encounter.

When should I use 99204?

A patient is examined with complaints of difficulty seeing out of the right eye, etc. A comprehensive history is taken and a comprehensive examination is performed. It is determined that the patient has a cataract and surgery is scheduled. The adjective is “Moderate,” so you would use CPT code 99204.

How much is a 99204 visit?

For new patient visits most doctors will bill 99203 (low complexity) or 99204 (moderate complexity) These codes pay $122.69 and $184.52 respectively. So, if you see a new doctor and your medical case is moderately complex you could expect to pay almost $37 for that visit.

What is the difference between a consultation and a referral according to CPT?

A consultation is a request by a qualified provider for the advice or opinion of a physician regarding the evaluation and/or management of a specific problem. A referral is the transfer of care from one physician to a second physician when the second takes over responsibility for treatment of the patient.

What is the difference between CPT code 99213 and 99214?

One PFSH. In a typical 99213 visit, you may not need to review or update the patient’s PFSH at all, but a 99214 requires at least one of those areas be reviewed and documented.

How many times a year can you bill 92014?

Eye code examination requirements vary among different Medicare contractors. You must have medical necessity for the service itself as well as each exam element you are performing. You cannot decide “I always bill 92014” twice a year. There must be medical necessity for the level of service in both sets of codes.

Is 99204 a consult code?

Report 99204 instead of 99244 for new patients. Report 99214 instead of 99244 for established patients. 99245 Office consultation for a new or established patient, which requires these three key components: • a comprehensive history; • a comprehensive examination; • and medical decision making of high complexity.

How many minutes is CPT 99204?

Using Time As the Key Factor for Evaluation and Management Visits​New Patient Visit​Typical Time (minutes)​Typical Time (minutes)​​99202​20​10​99203​30​15​99204​45​25​99205​60​40​1 more row

What does CPT code 99242 mean?

Office consultation99242: Office consultation for a new or established patient which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision-making.

What does CPT code 99499 mean?

unlisted serviceCPT. 99499 (unlisted service) must be used only in the rare circumstance where the visit does not reflect even the lowest level of E/M service in an applicable code family yet still evidences medical necessity. Supporting documentation must be provided to help a payer determine a payment amount.