Evaluate Billing Proper CPT Levels 99212 – 99215 Using Patient Charts
Do Not Hesitate About Billing The Proper CPT Code
If you feel hesitant about billing higher CPT levels, you may need to find some way to measure the amount of work that is actually being done during each visit. Under these circumstances, your chart notes can easily be amended to create crucial visual reminders. For example, if you use electronic medical records, it is fairly easy to create a form that you can fill in with details as you work with the patient.
CPT code 99212 – CPT code 99215
When trying to choose between codes 99212, 99213, and 99214, and 99215 you should start by understanding the basic framework that all three codes are built on. Basically, you will have to keep five general areas in mind:
History
Physical exam
Medical Decision Making complexity
Medical necessity
Time spent with the patient
As a general rule of thumb, CPT codes with higher numbers in a given set are meant to be used for more detailed or more complex visit types. For example, if you have a patient that may have a life threatening condition, you are likely to spend 25-40 minutes with them. This will inevitably include reviewing the medical history of the patient, as well as evaluating any number of exams and reports. Even though you may only use one or two diagnosis codes for the visit, it can still be billed as a 99214 and sometimes 99215 if the proper criteria is met.
Document the Time of Your Patient Visits
During the process of setting up a chart note form to assist with medical billing, you should make a point to document starting and ending time of each visit. When you go back and review the assigning of the CPT code, you will immediately know whether you will need to discuss this code with the provider to modify it appropriately up or down from what was being planned.
Next, you should create your form so that all five general areas are represented on the form. Ideally, you should separate the medical history section from physical exam notes as well as any laboratory or other tests performed discussed or ordered during the visit. After you complete your notes, it will be fairly easy to rate each section in order to determine which code is most suitable. If you find that two out of the three sections that follow the E/M guidelines as well as medical necessity justify a higher code than usual, you should go ahead and discuss the proper CPT code with the medical provider before you use that code.
Bill at Higher Level Office Visits v. Modifiers
Many medical providers today feel that they will be better off adding additional modifiers to add-on procedures rather than simply billing at a higher level for office visits. On the other hand, it is vital to realize that 25 and other modifiers are increasingly triggering Medicare and other insurance carrier audits. If you adjust your primary CPT code based on office notes, properly document the visit with the parameters that are set out by the guidelines you will run a much less risk of having to deal with these issues.
During the process of developing chart notes, you should always go back and review the guidelines related to the number of points required to meet a specific level of complexity. For example, you can create a form that enables you to document the appropriate components that should be part of a thorough exam. You can create a similar chart format for medical history review, medication adjustments, and conditions discussed during the exam.
In almost every case, once you start comparing this type of form to the actual guidelines for billing certain codes, you are likely to find that you have been exceeding the guidelines on a routine basis. Rather than continuing to getting paid only part of your labor, you can take steps to ensure that you finally get paid what you deserve for a full days work. You do the work now get paid for what you do.