How to use CPT code 99212
Code 99212 represents an existing patient appointment that’s at least 10 minutes in duration.
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How to use CPT code 99215
Billing and coding
How to use CPT code 99214
Code 99214 represents an existing patient appointment that’s at least 30 minutes in duration.
The 99214 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
CPT code 99214 description
Code 99214 represents an existing patient appointment that’s at least 30 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99214 in the official CPT codebook:
CPT code 99214: Existing patient office visit, minimum 30 minutes
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
If you spent at least 30 minutes with a client but the case was especially complex or high risk, or involved reviewing or analyzing a lot of data, you may use a higher CPT code, including 99215 (high MDM).
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
99214 vs 99204: Existing patient vs. new patient
If you’re treating a new patient, you should use 99204 instead. A new patient is someone you have not seen in the last three years.
CPT code 99214 time frame
CPT code 99214 documentation
Documentation for 99214 is essentially the same as other E/M codes, but geared toward an existing patient.
- Problem-focused history: Document relevant information about the patient’s presenting complaint, medical history, and any other important factors
- Problem-focused examination: Perform and document an evaluation that’s appropriate for the patient’s presenting complaint
- Moderate complexity medical decision making: Make a judgment about the patient’s diagnosis, create a care plan, and prescribe appropriate treatments or interventions. You can find a full table of levels and elements of MDM here.
- If you are billing based on time, include start/stop timers.
In the example note below, the following factors are present:
- Number and complexity of problems addressed: Chronic illness (major depressive order recurrent) with exacerbation
- Data reviewed/analyzed: None
- Risk: Moderate - prescription drug management
The encounter meets the criteria for a 99214 code based on the moderate level of medical decision-making required for managing the exacerbation of a chronic illness. This includes moderate complexity in prescription drug management, evidenced by the adjustment of medication dosages and addition of adjunctive therapy.
The treatment plan also incorporates multiple steps to address the patient's current symptoms and mitigate risks associated with exacerbation, emphasizing the need for ongoing monitoring and psychotherapeutic intervention.
Patient Name: Emily Thompson
Date of Service: 10/23/2024
Patient DOB: 07/14/1986
Appointment Time: 9:00 am – 9:45 am
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
Subjective
Chief Complaint: Follow-up consultation for a 38-year-old Caucasian female experiencing a recurrence of symptoms related to chronic major depressive disorder (MDD).
HPI:
Ms. Thompson reports a worsening of depressive symptoms, including increased feelings of hopelessness, persistent fatigue, and decreased interest in previously enjoyable activities. She describes difficulty concentrating, anxiety and disruptions in sleep, with frequent awakenings throughout the night. Ms. Thompson expressed frustration with the impact of her symptoms on her functioning and relationships.
Objective
Allergies: No known drug allergies.
Substance Use Assessment: Denies use of tobacco, alcohol, or recreational drugs.
Exam: Vital signs within normal limits. Psychomotor retardation noted. Mood observed as consistently low throughout the examination.
MSE:
- Appearance: Appropriately dressed, appears stated age.
- Behavior: Psychomotor retardation observed.
- Speech: Normal rate, tone, and volume.
- Mood: Low throughout the session.
- Affect: Restricted.
- Thought Process: Logical and coherent.
- Thought Content: Fleeting thoughts of self-harm; no delusions or hallucinations.
- Cognition: Alert and oriented x3.
- Insight/Judgment: Good insight and sound judgment.
Assessment
Dx: F33.2 Major depressive disorder, recurrent severe without psychotic features
F41.3 Other mixed anxiety disorders
Plan
Medication Adjustments:
- Increase fluoxetine from 40 mg to 60 mg daily to address symptom exacerbation.
- Add quetiapine 25 mg at bedtime for mood stabilization and improved sleep.
Referral for Intensive Psychotherapy: Arrange bi-weekly CBT sessions focused on symptom management and relapse prevention.
Safety Monitoring: Implement a structured safety plan to address any emergent suicidal ideation or self-harm behaviors.
Follow-up and Next Steps: Schedule a follow-up appointment in two weeks to monitor treatment response and side effects.
Electronically signed by:
[Provider Name, Credentials, Date]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Rationale and How the CPT Codes Were Selected (based on 2/3 elements):
- Number and Complexity of Problems Addressed: 2 Chronic illnesses: (MDD, recurrent) with exacerbation and Other mixed anxiety disorders
- Data Reviewed/Analyzed: None.
- Risk of Complications and/or Morbidity: Moderate (due to prescription drug management).
Rationale: The client displays Moderate number and complexity of problems with 2 chronic illnesses with exacerbation, No data reviewed, Moderate risk addressed by prescription drug management
CPT Code Selected: 99214
CPT code 99214 reimbursement rates
Reimbursement rates for sessions billed with 99214 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Billing and coding
How to use CPT code 99212
What you need to know about billing for telehealth
Here's how to bill for telehealth appointments, which CPT codes to use, and more.
How to use CPT code 99215
Code 99215 represents an existing patient appointment that’s at least 40 minutes in duration.