Both the CPT codes 99213 vs 99214 deal with billing in outpatient settings, which includes doctor’s offices and clinics for both evaluation and management services.
Some might think these codes are similar because they belong to the same family, but there is a big difference between 99213 and 99214 CPT codes in the level of service they present.
Many medical practitioners need help in selecting the right code between these two. The extreme importance to thoroughly understanding of the difference as one code to deals with their RCM.
By having a thorough understanding, healthcare settings can receive full reimbursement for their services. In this detailed guide, we will discuss the major differences between 99213 vs 99214 CPT codes that will help practices meet their revenue goals.
CPT Code 99213
The CPT code 99213 is utilized to invoice for billing services related to assessment and management. This code is used if a patient’s condition requires a mid-range level of medical decision-making.
Normally, when the patient’s medical condition is stable and just requires follow-up or looking to find the answers to some health-related questions, CPT code 99213 is preferred.
To get reimbursements for CPT 99213, the visit must meet two out of the following three main components:
History and Examination are a Must
The provider must conduct a comprehensive review and physical examination of the patient’s medical state.
Medical Decision-Making
The doctor must exhibit moderate medical decision-making when handling the patient’s medical state. This entails considering the patient’s medical history, laboratory results, and treatment options that are currently available.
Amount of Time Spent
The doctor is required to have a minimum of 15 minutes of face-to-face interaction with the patient.
CPT Code 99214
If a patient’s medical condition is complex and the visit involves a higher degree of medical decision, CPT code 99214 is used. Usually, this code is used for both the initial visits and follow-up visits where the doctor is accessing and the condition requires more time and attention.
To get reimbursements for CPT 99214, the visit must meet two out of the following three main conditions:
History and Examination
The provider must need to perform a detailed examination and carry out a comprehensive history of the patient’s medical state.
Medical Decision-Making
The doctor must exhibit a high level of medical decision-making when handling the patient’s medical state. The process consists of taking into account the patient’s medical background, laboratory reports,and available treatment alternatives.
Amount of Time
It is mandatory for the doctor to spend at least 25 minutes with the patient in person.
Differences between CPT Codes 99213 and 99214
The major difference between CPT codes 99213 vs 99214 is the level of service they deal with. The CPT 99214 code is use as it deals with a higher level of medical decision-making.
For these types of conditions, to get to know better, the doctor will spend more time in assessment and suggest the right treatments. Another core difference between CPT codes 99213 vs 99214 is the amount of time a provider must spend in person with the patient.
For the CPT code 99214, the doctor must spend a minimum of 25 minutes, while the in-person time for the CPT code 99213 is only 15 minutes. This implies that consultations billed using CPT code 99214 demand more time and attention from the physician.
Lastly, the reimbursement rate for the above two codes is quite different. For a higher rate, CPT code 99214 is used, while CPT code 99213 is used for lower reimbursements. Get More Information for the latest CPT Codes (Current Procedural Terminology).
Conclusion
Both CPT codes 99213 and 99214 are used for billing for evaluation and management services in outpatient settings.
These codes seem similar, but there is a lot of difference between 99213 and 99214 in terms of the level of services they represent, the amount of time the provider requires to spend with the patients in person, and the reimbursement rate.
With proper knowledge of 99213 vs 99214 CPT codes, the providers can make sure they are not leaking any revenue.
FAQs
Both the CPT codes 99213 and 99214 deal with the billing for evaluation and management services delivered by medical professionals in outpatient settings, including clinics and healthcare facilities.
The major difference between CPT codes 99213 and 99214 is the level of service they deal with. For complex medical conditions that require a higher level of medical decision-making, CPT code 99214 is used. For mid-range medical decision-making, CPT code 99213 is used.
To use medical billing CPT code 99213, the visit must meet two out of the following three main components: history and examination, medical decision-making, and at least 15 minutes spent in person with the patient.
To use CPT code 99214, the visit must meet two out of the following three main conditions: detailed examination and comprehensive history of the patient’s medical state, high level of medical decision-making, and at least 25 minutes spent in person with the patient.
CPT code 99214 is used for higher reimbursements compared to CPT code 99213.
Medical practitioners can choose the right CPT code by thoroughly understanding the differences between CPT codes 99213 and 99214 and ensuring that the visit meets the requirements for the chosen code. This will help them maximize reimbursements for their services.
