Medical Billing

Various Office Visit Codes You Should Be Aware Of

The Current Procedural Terminology (CPT) systems were developed by the American Medical Association (AMA). The CPT will ensure that the healthcare data are gatherers accurately and health claims are correctly and efficiently processed for Medicare, Medicaid, and other health programs. That is why for a person in the medical field, learning all about this standardized coding system is crucial. One of those is how to use the office visit codes.

CPT 99201 – 10 Minutes

This is used for office or outpatient visits for new patients. CPT 99201 requires three components – expanded problems focused on history, examination, and straightforward medical decisions. It also includes counseling and recommending care with other doctors as needed will depend on their issues and needs. The presenting problems are most often self-limited or very minor. CPT 99201 givs a 10-minute face-to-face time allowance with the patient or the family. The bill is 1 unit per visit.

CPT 99202 – 20 Minutes

It is similar to what is covered in CPT 99201. The difference is that, with CPT 99202, the presenting problems are usually low to moderate severity. Also, the time allotted for face-to-face with the patient or the family is increased to 20 minutes. The bill is 1 unit for every visit.

CPT 99203 – 30 Minutes

Like the other Office visit CPT codes, CPT 99203 is also used for office or outpatient visits, specifically for evaluating and managing new patients. It has three components – a detailed history, examination, and decision making of low complexity. And for this code, the time spent face-to-face with a patient or the family is 30 minutes. And the bill is still 1 unit per visit.

Office visit CPT codes

CPT 99204 – 45 Minutes

What makes the CPT 99204 different from the rest of the codes is that this is specifically for cases presenting moderate to high severity problems. A face-to-face time allotment of 45 minutes is given to patients or family. And like the rest, the bill instruction is one per unit visit.

CPT 99205 – 60 Minutes

This code has the most significant time allotment for a face-to-face meeting with the patient or the family. It is specifically used for cases of moderate to high severity. The bill instruction is also one unit for every visit.

Defining a New Patient

When coding, you must understand the difference between the new patient and the established ones. And when defining a ‘new patient,’ this means that the person or family has not sought nor received healthcare treatment from any medical professional for the past three years. An ‘established patient’ is a person who has received medical services from healthcare providers that are in the same group for the past three years.