cpt 99213, cpt code 99213, 99213 cpt code

CPT 99213 | Outpatient E/M Services | Established Patient | 20-29 Minutes

CPT 99213 is used for billing for an evaluation and management service provided to an established patient in an outpatient setting with a low level of medical decision-making and a total time spent on the encounter date of 20-29 minutes.

What Is CPT Code 99213?

CPT code 99213 refers to an evaluation and management (E/M) service for an established patient in an outpatient setting.

CPT 99213 includes a range of activities such as reviewing tests and preparing for the patient visit, performing the evaluation, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, and more.

Description

The CPT book describes CPT 99213 as: “Office or other outpatient visits 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 conducts an evaluation and management (E/M) service for an established patient in an outpatient setting.

CPT 99213 includes both face-to-face and non-face-to-face activities, such as reviewing tests and preparing for the patient visit, performing the evaluation, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care.

The total time spent on the encounter date is between 20-29 minutes, and the level of medical decision-making involved is low.

The visit may also include taking a patient history and performing a physical examination, as determined by the provider.

Elements of medical decision-making include 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.

How To Use CPT 99213

CPT code 99313 is an E/M code that can be used for services that require a low level of decision-making.

To choose the appropriate level of evaluation and management (E/M) service for an office or other outpatient setting, consider the total time spent on the encounter date or the level of medical decision-making involved, as stated in the code descriptor.

The service should include a medically appropriate history and/or physical examination if performed, and the provider determines the extent of these components.

Note that the extent of the history and examination does not affect the selection of E/M codes CPT 99202 until CPT 99215. It is essential to document all services provided in the medical record properly.

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