The Basic Difference Between 99213 and 99214 in Terms of Reimbursement
Posted on September 18, 2010 | No Comments
Adam Alpers asked:
Basic primary care is a department that can generate a lot of money through the different levels of the care and medical treatment that is rendered to the patients. But it is sometimes overlooked and ignored thereby failing to explore areas that lay uncovered and unexplored but have a tag with great returns.
Medical coding in the right manner will definitely help a lot since it is the basic way of earning money and is the major source of revenue through reimbursements in the medical profession. Though there are many levels of coding according to the illness, the right set of coding understood and developed will let you enjoy the benefits in a higher level. There always lies confusion in the basic difference between the 99213 and the 99214 coding in terms of revenue and the service rendered.
CPT ’99213′ basically translates as ‘Expanded Problem With Focused History’. The general misconception related to the coding of general routine visits and regular checkups are that related to this level of coding. But what a doctor must understand is that the complexity involved and the medical decision plays a pivotal role in deciding as to which group the office visit falls in. This is based on the following parameters: level of risk involved, the problems addressed and the data reviewed. A very good way of determining the same is to open up a tabular column highlighting all these issues and add points to each of them according to the issues addressed. This is called a data table and helps a lot in coding of the treatment.
The next factor that is pivotal is the level of complexity involved: Medium or Low. To this factor, addressing through the data table seems awkward and cumbersome, but a systematic approach will definitely help in either way. For example: treating a patient of bronchitis with a medicine that for whatever reason fails, will let you check the symptoms again and change therapy or prescribe an alternative drug and ask the patient to get back to you for a consultation. By this, you will understand and know the complexity involved with the case and code accordingly. Another misconception is the amount of paper work and the documentation involved in these processes. Just because a case involves more paper work, it can never be stated as critical and grouped under the moderate complexity group.
CPT ’99214′ on the other hand requires moderate complexity and decision making in the case. Take the same example as stated above: adding hypertension and diabetes to the above existing problem will make the decision more complex since the drug given to counteract both the existing ailment along with the evaluation for the different disease entities as well as treating the bronchitis.
The clinical intuition and the medical experience will guide you through all this processes, but then the ultimate solution rendered will decide as to which group this will belong to. But the returns will differ since the services rendered are different. While the former has a lower return the latter has a higher return, but your coding must reflect the intensity of service that you rendered. Once you learn to accurately code in the right way, you get paid the appropriate amount for the work you do. You do the work; get paid for what you do.
cpt codes 2011
Basic primary care is a department that can generate a lot of money through the different levels of the care and medical treatment that is rendered to the patients. But it is sometimes overlooked and ignored thereby failing to explore areas that lay uncovered and unexplored but have a tag with great returns.
Medical coding in the right manner will definitely help a lot since it is the basic way of earning money and is the major source of revenue through reimbursements in the medical profession. Though there are many levels of coding according to the illness, the right set of coding understood and developed will let you enjoy the benefits in a higher level. There always lies confusion in the basic difference between the 99213 and the 99214 coding in terms of revenue and the service rendered.
CPT ’99213′ basically translates as ‘Expanded Problem With Focused History’. The general misconception related to the coding of general routine visits and regular checkups are that related to this level of coding. But what a doctor must understand is that the complexity involved and the medical decision plays a pivotal role in deciding as to which group the office visit falls in. This is based on the following parameters: level of risk involved, the problems addressed and the data reviewed. A very good way of determining the same is to open up a tabular column highlighting all these issues and add points to each of them according to the issues addressed. This is called a data table and helps a lot in coding of the treatment.
The next factor that is pivotal is the level of complexity involved: Medium or Low. To this factor, addressing through the data table seems awkward and cumbersome, but a systematic approach will definitely help in either way. For example: treating a patient of bronchitis with a medicine that for whatever reason fails, will let you check the symptoms again and change therapy or prescribe an alternative drug and ask the patient to get back to you for a consultation. By this, you will understand and know the complexity involved with the case and code accordingly. Another misconception is the amount of paper work and the documentation involved in these processes. Just because a case involves more paper work, it can never be stated as critical and grouped under the moderate complexity group.
CPT ’99214′ on the other hand requires moderate complexity and decision making in the case. Take the same example as stated above: adding hypertension and diabetes to the above existing problem will make the decision more complex since the drug given to counteract both the existing ailment along with the evaluation for the different disease entities as well as treating the bronchitis.
The clinical intuition and the medical experience will guide you through all this processes, but then the ultimate solution rendered will decide as to which group this will belong to. But the returns will differ since the services rendered are different. While the former has a lower return the latter has a higher return, but your coding must reflect the intensity of service that you rendered. Once you learn to accurately code in the right way, you get paid the appropriate amount for the work you do. You do the work; get paid for what you do.
cpt codes 2011