Overview of CPT Codes 99202–99215
CPT codes 99202 through 99215 represent the range of office/outpatient evaluation and management (E/M) services for both new and established patients. These codes are essential for accurately documenting patient encounters and for proper billing and reimbursement. They are determined by the components of History, Examination, and Medical Decision Making (MDM) and can be supported either by key components or total time spent with the patient.
Key Topics Covered
- Billing: Understand how CPT codes drive billing processes and affect reimbursement levels based on the complexity of care provided.
- Documentation: Proper documentation is critical. It must support the chosen code level and include detailed patient information.
- Description & Definition: Each code comes with a detailed description and definition, outlining what is expected in terms of history, exam, and MDM.
- Meaning & Time: The “meaning” of these codes relates to the complexity of the encounter, with time being a crucial factor when time-based coding is used. Documentation of the time spent with the patient helps justify higher-level codes.
- Modifier 25: This modifier is applied when a significant, separately identifiable E/M service is provided by the same physician on the same day as another procedure.
- Modifier 95: Used for telehealth services, it ensures that services provided via real-time interactive audio and video telecommunications systems are appropriately identified for billing and reimbursement.
- Reimbursement & Cost: Proper code selection directly affects reimbursement from payers and can influence the overall cost of care. Accurate coding ensures that providers are reimbursed fairly while controlling cost for patients and insurers.
Explore the individual code pages and additional resources for further details on how each element contributes to accurate and efficient coding.