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CPT 99214 | How To Bill Level 4 Office And Outpatient Visits (2023)

CPT code 99214 is a code used by healthcare professionals to describe a level 4 office or outpatient visit, which is typically more complex and requires more time than a level 3 visit (CPT 99213) and may be billed with other codes to describe additional services provided during the visit.

1. What Is CPT Code 99214?

CPT 99214 is a code healthcare professionals use to describe a level 4 office or outpatient visit.

This visit is typically more complex and requires more time than a level 3 visit (CPT 99213). It is typically used when a patient has multiple medical problems that need to be addressed or when a patient has a single complex issue that requires a detailed evaluation and management.

During a level 4 office or outpatient visit, the healthcare professional reviews the patient’s medical history performs a physical examination, and orders or interprets diagnostic tests as needed.

The healthcare professional also provides counseling and education to the patient, develops a treatment plan, and coordinates the patient’s care with other healthcare providers as needed.

2. Description

The CPT book describes CPT code 99214 as follows: “Office or another outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a moderate level of medical decision making. When using time for code selection, 30-39 minutes of the total time is spent on the date of the encounter.”

3. How To Use CPT Code 99214

The time required for a level 4 office or outpatient visit is typically longer than a level 3 visit. However, the time necessary will depend on the complexity of the patient’s medical problems and the provided services.

The complexity of a level 4 office or outpatient visit is typically higher than a level 3 visit (CPT 99213). This means that the healthcare professional must perform a more detailed evaluation and management of the patient’s medical problems, and the visit may involve more time and services.

99214 is often used for follow-up visits, where the healthcare professional monitors the patient’s progress or adjusts their treatment plan based on their progress.

CPT code 99214 is typically used for patients with multiple medical problems that need to be addressed or for patients with a single complex medical problem that requires a detailed evaluation and management.

99214 is often used with other codes to describe additional services provided during the visit. For example, the healthcare professional may use codes to describe any diagnostic tests that are ordered, any procedures that are performed, or any prescribed medications.

During a level 4 office or outpatient visit, the healthcare professional may review the patient’s medical history, physical examination, and necessary diagnostic tests. They may also provide counseling and education to the patient, develop a treatment plan, and coordinate the patient’s care with other healthcare providers as needed.

CPT code 99214 is just one of many codes used to describe office or outpatient visits.

There are other codes for different levels of complexity and various types of visits, such as new patient visits, established patient visits, and consultations. Other codes include CPT 99213 (level 3 visit) and CPT 99212 (level 2 visit), which are used for less complex visits, and CPT 99215 (level 5 visit), which is used for more complex visits.

3.1 Time Requirements

A level 4 office or outpatient visit typically requires more time than a level 3 visit (CPT 99213). However, the time necessary will depend on the complexity of the patient’s medical problems and the provided services.

3.2 Medical Necessity

99214 is typically used for patients who have multiple medical problems that need to be addressed or for patients who have a single complex medical problem that requires a detailed evaluation and management.

3.3 Documentation

Healthcare providers should document the services they provide to patients in the patient’s medical records.

This documentation should include a comprehensive review of the patient’s medical history, physical examination, and any necessary diagnostic tests. It should also describe the treatment plan and any counseling or education provided to the patient.

3.4 Modifiers

Modifiers may be used to indicate that the services provided were more complex or required more time than the typical level 4 office or outpatient visit.

3.5 Reimbursement

The amount of reimbursement that a healthcare provider will receive for a CPT code 99214 visit will depend on the specific details of the visit and the terms of the patient’s insurance policy.

It is essential for healthcare providers to accurately report the services they provide using the appropriate CPT codes to ensure that they receive proper reimbursement for their services.

3.6 What Is The Difference Between CPT Code 99213 And 99214?

Healthcare professionals use CPT codes 99213 and 99214 to describe office or outpatient visits. The main difference between these codes is the complexity of the visit.

CPT 99213 describes a level 3 office or outpatient visit, typically less complex than a level 4 visit (CPT 99214).

During a level 3 visit, the healthcare professional typically performs a comprehensive review of the patient’s medical history, performs a physical examination, and orders or interprets diagnostic tests as needed.

The healthcare professional also provides counseling and education to the patient, develops a treatment plan, and coordinates the patient’s care with other healthcare providers as needed.

CPT code 99214 describes a level 4 office or outpatient visit, which is typically more complex and requires more time than a level 3 visit. The time needed for a level 4 visit will depend on the complexity of the patient’s medical problems and the provided services.

Here is a summary of the main differences between CPT 99213 and 99214:

  • CPT 99213 is used for level 3 visits, which are less complex than level 4 (CPT 99214).
  •  CPT 99214 is used for level 4 visits, which are more complex and typically require more time than level 3 visits.
  •  The services provided during a visit will determine which CPT code is used. Healthcare professionals should use the code that accurately reflects the complexity and time required for a visit.

3.7 Can CPT Code 99214 And 93000 Be Billed Together?

Yes, CPT codes 99214 and 93000 can be billed together. CPT code 99214 describes a level 4 office or outpatient visit, typically a comprehensive evaluation and management of the patient’s medical problems.

CPT code 93000 is used to describe a diagnostic electrocardiogram (ECG), which is a test that records the electrical activity of the heart.

If a healthcare provider performs both a level 4 office or outpatient visit and an ECG during the same patient encounter, then both CPT codes 99214 and 93000 may be billed together.

In this case, the healthcare provider would submit both codes to the patient’s insurance company to request reimbursement for the services provided.

3.8 Can CPT Codes 99214 And 99496 Be Billed Together?

Yes, CPT codes 99214 and 99496 can be billed together. CPT code 99214 describes a level 4 office or outpatient visit, typically a comprehensive evaluation and management of the patient’s medical problems.

CPT code 99496 describes a transitional care management service, a type of care provided to patients transitioning from one level of care to another (e.g., inpatient to outpatient care).

If a healthcare provider performs both a level 4 office or outpatient visit and a transitional care management service during the same patient encounter, then both CPT codes 99214 and 99496 may be billed together.

4. Resources

Coders’ Specialty Guide 2023: General Surgery (Volume I & II)

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