CPT Code 99212: Established Patient Office or Other Outpatient Visit, 10-19 minutes

What is the 99212 CPT code?

CPT code 99212, which has an evaluation and management definition of "Established patient office or other outpatient visit, 10-19 minutes," is one of the management codes used for evaluation and management services involving an established patient.

This visit requires a problem-focused history, a problem-focused examination, and straightforward medical decision-making. The office visit typically lasts 10-19 minutes and is used for minor acute conditions or brief follow-ups, and not for critical care services.

CPT code 99212 documentation requirements

During documentation, healthcare providers must make sure to follow the documentation guidelines that state that there should be at least two components in the patient's medical record so that the coding and billing are accurate:

• Chief complaint and brief medically appropriate history
• Limited physical examination
• Straightforward medical decision-making

CPT code 99212 billing guidelines

For a smooth medical billing process and increased chances of appropriate reimbursement, healthcare providers must consider the following billing guidelines:

• For established patients only
• Must meet at least two out of three required components
• Time-based coding is applicable if the time spent during the patient visit is at least 10 minutes

Other relevant CPT codes

• 99211: Lower complexity, typically for nurse-only visits
• 99213: Higher complexity E/M visit