What CPT Code 99213 Is And What It's Used For
CPT code 99213 is used to denote a regular office visit to a primary care physician. It is frequently used by providers for a range of very general office visits, whether an individual is in need of treatment for a minor illness or an expanded problem. In order to qualify for payment from insurance agencies, these visits must meet two of three standard criteria.
First, an individual should receive a focused medical exam, which means that the provider is clearly assessing the individual for one specific issue or a specific concern. This must require a very moderate amount of decision-making. If the health problem becomes much more involved and more time with the provider is required, alternative codes will have to be used that are more specific to the nature of the patient's actual needs and the requested amount of compensation.
Other criteria include expanded problems and expanded problems with focused histories. If two of these three requirements are not met, the request is likely to be denied and their could be considerable delays in getting the request for monies processed. This is not uncommon given that the coding process is a highly complex one with plenty of room for error.
There are other vital facts that must be included in the billing statements as well. Foremost among these is identifying information that helps the insurance company determine whether or not the party is indeed insured and whether the coverage will apply to the services rendered. Although many codes are very general, they must typically be used with the proper sub-coding in order to supply insurance agencies with a comprehensive understanding of patient needs and the provider response.
All of these things together show whether or not the coverage is being taken advantage of. If an insurance agency is not satisfied with the information that is supplied or takes issue with conflicting or inaccurate details, providers still have the opportunity to collect. They simply need to submit formal appeals and then pursue these things.
One of the best things about CPT code 99213 is that it fits a broad range of circumstances and often makes it easier for billing specialists to complete individual invoices. With a comprehensive understanding of this term and the procedures that it covers, billing professionals are much closer toward preparing a proper request for payment. Best of all, changes are constantly being introduced that help to simplify this process and make it much less time-consuming overall.