CPT Code 99213: Established patient office visit, 20-29 minutes

What is CPT code 99213?

CPT code 99213 is one of the CPT codes maintained by the American Medical Association (AMA), used in the healthcare industry, that refers to an office or other outpatient visit that involves evaluation and management services. It can represent a level 3 outpatient office visit.

According to the AMA, 99213's code description is "Established patient office visit, 20-29 minutes," and it typically applies to established patients whose visit may:

• include low-level medical decision-making
• require an appropriate medical history and/or examination

This code is commonly used by healthcare providers in their medical practice, specifically during scenarios such as follow-up visits, routine check-ups, etc.

CPT code 99213 documentation requirements

Here are all the requirements healthcare professionals need to keep in mind for consistent and accurate documentation and coding:

• Expanded-problem focused history: For proper documentation of the patient's medical history, the patient's chief complaint, extended history of present illness (HPI), and pertinent review of systems (ROS) must be present.
• Expanded problem-focused examination: In this component, the results of tests for vital signs and measurements, as well as observations for any impairments or limitations, must be written down.
• Medical decision making (MDM): For this section, the healthcare provider must mention and/or elaborate on the diagnosis and treatment plan, including any risks the patient may have.
• Time-based reporting: If billing is based on time, documentation must reflect that 20-29 minutes were spent on patient care by describing what was done during that time.

CPT code 99213 billing code guidelines

After a healthcare provider conducts accurate and thorough documentation, they may bill their medical services. For ease of the billing process, here are the guidelines one can follow:

• Used for established patients seen in an outpatient setting.
• Documentation must justify medical necessity and the level of service provided.
• Ensure compliance with payer-specific rules, as some insurers require specific documentation elements.

Other relevant CPT codes

• 99212: Visits with straightforward MDM (10-19 min).
• 99214: Visits with moderate MDM (30-39 min).