CPT 99212 can be used for billing an evaluation and management service provided to an established patient in an outpatient setting, such as a doctor’s office, involving straightforward medical decision-making and/or a total time of 10-19 minutes spent on the encounter on a single date.
What Is CPT Code 99212?
CPT code 99212 describes an evaluation and management (E/M) service provided to an established patient in an outpatient setting, such as a doctor’s office.
CPT 99212 includes various activities, including reviewing the patient’s medical history, performing a physical examination, counseling and educating the patient or caregiver, ordering tests, and coordinating care with other healthcare providers.
The total time for the service is 10-19 minutes, and the level of medical decision-making (MDM) does not require a high level of complexity or risk.
To use code 99212, the provider must have spent at least 10-19 minutes on the date of the encounter on both face-to-face and non-face-to-face activities related to the service.
99212 is used for billing for regular check-ups or follow-up visits with an established patient.
The CPT book describes CPT code 99212 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 straightforward medical decision making. When using time for code selection, 10-19 minutes of the total time is spent on the date of the encounter.”
A provider performs an evaluation and management (E/M) service for an established patient either in their office or at another outpatient setting.
The service includes a range of activities, such as reviewing tests and preparing for the patient visit, conducting the exam or evaluation, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating test results, and coordinating care.
The total time for the service is 10-19 minutes, and the level of medical decision-making (MDM) is straightforward.
The MDM level is based on factors such as the number and complexity of problems addressed, the amount and complexity of data to review and analyze, and the risk of complications, morbidity, and mortality related to patient management.
The service may also include taking a patient history and performing a physical examination, with the provider determining the appropriate extent of these elements for the encounter.