Are you having trouble while billing code 99214? If yes, your struggles have come to an end. How? Because this guide is dedicated to decoding the code 99214. We will discuss what it is, why it is important, and what challenges healthcare providers typically face while reporting it. That’s not all! We will also share the care components needed for accurately billing this code.
So, without further ado, let’s get right into it!
What is CPT Code 99214?
The CPT code 99214 is a specifically designed evaluation and management (E/M) code for established patients requiring medical decision-making of moderate level, detailed examination, and history during their outpatient or office visit.
Besides, you may use it for patients with acute injuries or progressing illnesses needing surgical treatment or ongoing medical management.
Significance of CPT Code 99214 In Medical Billing
Here are a few reasons justifying the significance of billing code 99214:
Precise Representation
This code enables healthcare providers to represent their rendered care services based on their complexity and duration. It applies to established patient encounters at the outpatient facility or physician’s office. As a result, it promotes accurate and fair reimbursements.
Standardized Billing
Utilizing standardized codes, such as CPT code 99214, helps you optimize your billing workflow, minimize error rate, and ensure consistency.
Reimbursement Determinations
Moreover, code 99214 enables physicians to receive the rightful reimbursements from Medicare and private insurance companies.
Common Errors & Challenges in Reporting Code 99214
Medical coding is not a piece of cake as there are hundreds of CPT codes, with their prerequisites to follow through to avoid denials and delays in payment. Billing code 99214 is no different! Following are some of the challenges associated with this CPT code:
Issue of Undercoding
One of the challenges associated with billing CPT code 99214 is the issue of undercoding. Many healthcare providers undercode while submitting claims, even though it leads to lower reimbursements. Undercoding happens due to inadequate or missing documentation and can also make the payer consider it an act of fraud or scam, leading to penalties.
Complex Guidelines
Coding complexity is another issue faced by many healthcare practitioners. Besides, the E/M documentation guidelines are complex and often lead to errors while trying to bill the CPT code 99214.
Changes in CPT Coding
The CPT coding guidelines are subject to changes and regular updates, making it challenging for providers to follow through with the updates. As a result, while reporting CPT code 99214, clinicians may face compliance-related challenges.
Accurate Application of Billing Code 99214
When it comes to accurately billing the code 99214, the healthcare provider must understand the associated care components to avoid payment delays or claim denials.
CPT 99214 billing requirements will be discussed in this section. However, before we dive into the details, let’s take a glimpse into how the care components come together in a typical 99214 visit:
| Care Components | Documentation Requirements |
|---|---|
| Detailed History | Major complaint, past medical history, family history, social history, present illness, and review of systems. |
| Detailed Examination | Thorough examination of all relevant body parts. |
| Moderate Complexity Decision-Making | Diagnosis evaluations, and available treatments with their associated benefits and risks. |
Detailed History
A detailed history for the 99214 encounters requires you to note the patient’s chief complaint with their extended history of four or more present illnesses. Besides, you need to record the patient’s social or family history, which is directly related to their illness, such as smoking, etc. Also, you need to review 2-9 organ systems.
Detailed Examination
Examination is another core care element of the 99214 visit. It involves examining the affected area or organ system with other related body systems, vital signs, general appearance, etc., to gauge an understanding of the problem.
Medical Decision-Making
E/M coding emphasizes medical decision-making rather than physical examination and patient history. Thus, in the case of a 99214 encounter, moderate complexity decision-making is needed based on two of the following three factors:
- The complexity/amount of reviewed data
- The level of risk involved with diagnosing or managing the patient
- The amount of management options considered for treatment or diagnosis
Bottom Line
Healthcare providers and practitioners use the CPT code 99214 for billing their established patients’ E/M visits. These encounters are usually moderate complexity office or outpatient visits that last under an hour.
However, while reporting code 99214, providers may face challenges such as using the wrong or outdated code. If you require detailed documentation, have to perform a comprehensive medical examination, and must make a moderate decision, then the 99214 billing code can be used for timely reimbursements.
We hope this guide has helped you understand this E/M code better and help you accurately code it for future patient encounters.
