cpt 99205, cpt code 99205, 99205 cpt code

CPT 99205 | Office/Outpatient E/M For Established Patient (20-29 Minutes)

CPT 99205 describes an office or outpatient visit with a low level of medical decision-making that includes a medically appropriate history and/or examination and requires at least 20-29 minutes of the total time of the encounter on the date of the visit.

What Is CPT Code 99205?

The CPT code 99205 is used for office or outpatient visits to evaluate and manage an established patient that requires a medically appropriate history and/or examination and a low level of medical decision-making.

According to the CPT guidelines, at least 20-29 minutes of the total time of the encounter should be spent on the date of the encounter.

In this case, the provider met with a new patient for an evaluation and management service at an office or outpatient facility and spent 60-74 minutes on the encounter.

The medical decision-making process considered the number and complexity of problems being addressed, the amount and complexity of data to review and analyze, and the risk of complications, morbidity, and mortality related to the patient’s management.

Description

The CPT book describes CPT code 99205 as: “Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of the total time is spent on the date of the encounter.”

Procedure

The provider meets with a new patient for an appointment either in their office or at another outpatient facility for an evaluation and management service.

This visit included a high level of medical decision-making, and the provider spent 60-74 minutes on the encounter on a single date.

The time spent on the encounter included both face-to-face and non-face-to-face activities, such as;

  • ordering tests;
  •  communicating with other healthcare providers;
  •  performing the evaluation or examination;
  •  reviewing tests and preparing for the patient’s visit;
  •  counseling and educating the patient or caregiver;
  •  interpreting and communicating test results
  •  documenting the encounter;
  •  and coordinating care.

The medical decision-making process considered the number and complexity of issues being addressed, the amount and complexity of data to review and analyze, and the risk of complications, morbidity, and mortality related to the patient’s treatment plan.

How To Use CPT 99205

The CPT code 99205 includes a medically appropriate history and/or physical examination if deemed necessary by the provider.

The provider determines the extent and nature of the required history and/or exam. The level of history and exam does not impact the selection of evaluation and management codes CPT 99202, CPT 99203, CPT 99204, CPT 992011, CPT 99212, CPT 99213, CPT 99214, and CPT99215.

However, all services that are performed must be properly documented in the medical record. For services that last 75 minutes or longer, the prolonged services code add-on CPT 99417 should also be considered.

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