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99213

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Are You Prepared to Defend Your Coding? -- FPM

Jun 1, 2005 - The authors offer readers an action plan to use in reacting/responding to payers' accusations of incorrect coding.

Family Practice Management : Articles

https://www.aafp.org/fpm/2005/0600/p17.html

How to Document and Bill Care Plan Oversight -- FPM

May 1, 2005 - This article will describe how to bill for and document care plan oversight, balancing it as a billing opportunity and a compliance risk. It will include a form for documenting CPO.

Family Practice Management : Articles

https://www.aafp.org/fpm/2005/0500/p23.html

Coding & Documentation - May 2005 -- FPM

May 1, 2005 - ...otherwise does not meet the definition of a consultation, the office encounter should be coded using an office/outpatient visit code, such as 99213. In either case, modifier -25 should be appended to the E/M code to indicate that it was a significant, separately identifiable service...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2005/0500/p27.html

Coding & Documentation - Apr 2005 -- FPM

Apr 1, 2005 - ...99213 or 99214? Three Tips for Navigating the Coding Conundrum Don't Get Burned Coding Common Skin Procedures New Medicare Payment Opportunities Editor's Collections Coding Coding & Documentation Related Topic Searches CPT: Medicine codes MOST RECENT ISSUE...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2005/0400/p35.html

The Value of a Coding Education -- FPM

Mar 1, 2005 - The authors describe options for physicians and members of their staff who want to obtain certification in coding.

Family Practice Management : Articles

https://www.aafp.org/fpm/2005/0300/p20.html

Why It's Time to Purchase an Electronic Health Record System -- FPM

Dec 1, 2004 - The old reasons for holding off may have lost their validity.

Family Practice Management : Articles

https://www.aafp.org/fpm/2004/1100/p43.html

Group Visits Hit the Road -- FPM

Sep 1, 2004 - By taking group visits to his elderly patients, this physician found a way to meet their needs and those of his practice - and have fun at the same time.

Family Practice Management : Articles

https://www.aafp.org/fpm/2004/0900/p39.html

Are You Coding Accurately? -- FPM

Jun 1, 2004 - This article provides readers with step-by-step instructions for checking their E/M coding distribution with national guidelines established in the Centers for Medicare and Medicaid Family Practice Profile.

Family Practice Management : Articles

https://www.aafp.org/fpm/2004/0600/p20.html

Making Sense of Preventive Medicine Coding -- FPM

Apr 1, 2004 - Find out how to properly code and bill for the preventive services you provide.

Family Practice Management : Articles

https://www.aafp.org/fpm/2004/0400/p49.html

Coding for Depression Without Getting Depressed -- FPM

Mar 1, 2004 - Here is what you need to know to code and be reimbursed for counseling and treating patients with depression.

Family Practice Management : Articles

https://www.aafp.org/fpm/2004/0300/p23.html

Coding & Documentation - Oct 2003 -- FPM

Oct 1, 2003 - ...Medicare will allow you to submit G0101 in addition to an evaluation and management (E/M) service (e.g., 99213) if the E/M service is significant and separately identifiable from the G0101 service. An example would be if an established Medicare patient with chronic essential...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2003/1000/p16.html

Understanding When to Use the New Patient E/M Codes -- FPM

Sep 1, 2003 - Even an old patient can be new.

Family Practice Management : Articles

https://www.aafp.org/fpm/2003/0900/p33.html

Time Is of the Essence: Coding on the Basis of Time for Physician Services -- FPM

Jun 1, 2003 - Sometimes, coding is almost as simple as looking at the clock.

Family Practice Management : Articles

https://www.aafp.org/fpm/2003/0600/p27.html

Trouble at the Money/Medicine Interface -- FPM

Jun 1, 2003 - Argues that the reimbursement system's misalignment of incentives makes the health care system absurdly complicated and points to two articles in this issue as evidence.

Family Practice Management : Opinion

https://www.aafp.org/fpm/2003/0600/p8.html

Group Visits 101 -- FPM

May 1, 2003 - In addition to providing step-by-step instructions for launching group visits, the authors lay out the rationale for group visits and how to code for them.

Family Practice Management : Articles

https://www.aafp.org/fpm/2003/0500/p66.html

Coding Better for Better Reimbursement -- FPM

Jan 1, 2003 - Your work is worth more than you think. You just need to document and code it better.

Family Practice Management : Articles

https://www.aafp.org/fpm/2003/0100/p29.html

Monitor - Jan 2003 -- FPM

Jan 1, 2003 - ...Chiropractors charge an average fee of $51.94 for the established patient visit code 99213 and get paid an average of $47.97, for a reimbursement rate of 92 percent, reports Chiropractic Economics in its Second Annual Fees and Reimbursement Survey. The report goes on to say that the...

Family Practice Management : News Briefs

https://www.aafp.org/fpm/2003/0100/p20.html

Coding & Documentation - Nov 2002 -- FPM

Dec 1, 2002 - ...Medicare will allow you to submit G0101 in addition to an evaluation and management (E/M) service (e.g., 99213) if the E/M service is significant and separately identifiable from the G0101 service. An example would be if an established Medicare patient with chronic essential...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2002/1100/p30.html

Coding & Documentation - Oct 2002 -- FPM

Oct 1, 2002 - ...99213 or 99214? Three Tips for Navigating the Coding Conundrum What Can a PA or NP Do for Your Practice? An Update on Certifying Home Health Care Editor's Collections Coding & Documentation Related Topic Searches Time-based coding MOST RECENT ISSUE May-Jun...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2002/1000/p23.html

An Easy Way to Analyze E/M Coding for Group Practices -- FPM

Aug 1, 2002 - The author describes how practices can analyze their CPT coding distributions and determine whether they are billing for an appropriate range of services.

Family Practice Management : Articles

https://www.aafp.org/fpm/2002/0700/p20.html

Answers to Your Questions on Solo, Idealized Practice -- FPM

May 1, 2002 - How does a solo doc with no support staff manage his referrals, order his supplies and give immunizations? Gordon Moore, MD, answers those questions and more.

Family Practice Management : Articles

https://www.aafp.org/fpm/2002/0500/p39.html

11 Tips for More Productive Billing -- FPM

Mar 1, 2002 - The author, a practice administrator, offers 10 tips for improving the efficiency of billing and collection processes.

Family Practice Management : Articles

https://www.aafp.org/fpm/2002/0300/p16.html

Test Your Coding Skills -- FPM

Feb 1, 2002 - Go head to head with our review panel in coding six troublesome progress notes.

Family Practice Management : Articles

https://www.aafp.org/fpm/2002/0200/p41.html

Letters - Feb 2002 -- FPM

Feb 1, 2002 - ...My experience is that most physicians believe a normal visit starts at 99213 and that something special must be done to get to 99214. The majority of visits to family physicians involve either working up new health problems or following up multiple medical problems. I don’t know how...

Family Practice Management : Letters

https://www.aafp.org/fpm/2002/0200/p14.html

Monitor - Jan 2002 -- FPM

Jan 1, 2002 - ...receive small increases: 99211 (1.9 percent), 99212 (0.67 percent), 99214 (0.13 percent) and 99203 (0.56 percent). Reimbursement for code 99213 is scheduled to drop by 0.36 percent. At press time, efforts are underway in Congress to stop the reimbursement cuts and require that a new...

Family Practice Management : News Briefs

https://www.aafp.org/fpm/2002/0100/p21.html

Coding & Documentation - Jul 2001 -- FPM

Aug 1, 2001 - ...99213 or 99214? Three Tips for Navigating the Coding Conundrum The 2021 Office Visit Coding Changes: Putting the Pieces Together Combining a Wellness Visit With a Problem-Oriented Visit: a Coding Guide Editor's Collections Coding ICD-10 Coding Coding & Documentation...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2001/0700/p16.html

Letters - Jun 2001 -- FPM

Jun 1, 2001 - ...with the level of office visit you provided from the time you actually spent in face-to-face contact with the patient. The CPT manual says a 99213 typically involves 15 minutes of face-to-face time. Subtracting 15 from 70 leaves 55 minutes. Prolonged services code 99354 accounts for...

Family Practice Management : Letters

https://www.aafp.org/fpm/2001/0600/p13c.html

Letters - Jun 2001 -- FPM

Jun 1, 2001 - ...stay. I recommend using codes 99212-99215 instead. The reimbursement for 99212 would be roughly equal to that for 99499, but using codes 99213, 99214 or 99215 would generate higher reimbursement. A source at the Health Care Financing Administration’s (HCFA) regional office in Dallas...

Family Practice Management : Letters

https://www.aafp.org/fpm/2001/0600/p13d.html

Letters - May 2001 -- FPM

May 1, 2001 - ...In Planning Group Visits for High-Risk Patients [June 2000, page 33], the authors suggest using 99213 and 99214 to code group visits. We believe the appropriate codes are those suggested by Kent J. Moore in Answers to Your Questions [March 2000, page 21]: 99411 or 99412 for...

Family Practice Management : Letters

https://www.aafp.org/fpm/2001/0500/p15a.html

Coding & Documentation - Mar 2001 -- FPM

Mar 1, 2001 - ...with the level of office visit you provided from the time you actually spent in face-to-face contact with the patient. The CPT manual says a 99213 typically involves 15 minutes of face-to-face time. Subtracting 15 from 70 leaves 55 minutes. Prolonged services code 99354 accounts for...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2001/0300/p23.html

How to Stop Hemorrhaging Red Ink -- FPM

Mar 1, 2001 - This article lists tips practices can use to prevent lost revenues.

Family Practice Management : Articles

https://www.aafp.org/fpm/2001/0300/p16.html

Making Quality and Service Pay: Part 1, The Internal Environment -- FPM

Oct 1, 2000 - Insurers may not explicitly reward your practice for improved quality and service, but there is a way to make quality and service pay.

Family Practice Management : Articles

https://www.aafp.org/fpm/2000/1000/p48.html

House Calls: Taking the Practice to the Patient -- FPM

Jun 1, 2000 - Visiting patients where they live is not only good medicine and good marketing. It's also good for the soul.

Family Practice Management : Articles

https://www.aafp.org/fpm/2000/0600/p49.html

Planning Group Visits for High-Risk Patients -- FPM

Jun 1, 2000 - You'll not only have more satisfied patients and better compliance, but you'll also be compensated for your services.

Family Practice Management : Articles

https://www.aafp.org/fpm/2000/0600/p33.html

Coding & Documentation - May 2000 -- FPM

May 1, 2000 - ...CPT code is to code the five-digit version of the modifier in addition to the CPT code. For example, instead of coding 99213–25, you can code 99213 and 09925. The five-digit version of a CPT modifier is always 099XX, with XX being the two digits otherwise associated with the...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2000/0500/p22.html

Using Peer Review for Self-Audits of Medical Record Documentation -- FPM

Apr 1, 2000 - You might be surprised at how much doctors can help one another improve in coding and documentation.

Family Practice Management : Articles

https://www.aafp.org/fpm/2000/0400/p28.html

Ask FPM - Mar 2000 -- FPM

Mar 1, 2000 - ...by Medicare and many other third-party payers to determine physician reimbursement, a level-III established patient office visit (i.e., code 99213) has a total of 1.29 RVUs assigned to it. Under RBRVS, a code's total RVUs is the sum of three components: work RVUs, practice-expense...

Family Practice Management : Q&As

https://www.aafp.org/fpm/2000/0300/p60.html

A Quick-Reference Card for Identifying Level-4 Visits -- FPM

Aug 1, 1999 - The author's tool will help you keep in mind what qualifies a visit for a 99214 or a 99204.

Family Practice Management : Articles

https://www.aafp.org/fpm/1999/0700/p32.html

Should You Modify Your Use of Modifiers? -- FPM

May 1, 1999 - This article explains how to use modifiers commonly attached to CPT codes for family physicians' services.

Family Practice Management : Q&As

https://www.aafp.org/fpm/1999/0500/p18.html

Coding & Documentation - Apr 1999 -- FPM

Apr 1, 1999 - ...Can I code 99455 for a work-related or medical disability evaluation as well as a regular office-visit code (such as 99213) for the same encounter, if it's appropriate? A Yes. Code 99455 is one of three used to report evaluations required for life or disability insurance...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/1999/0400/p12.html

Monitor - Jul 1998 -- FPM

Aug 1, 1998 - ...As an example of the likely increases under the revised proposal, the practice-expense payments for 99213 visits would rise almost 23 percent less than they would have under last year's proposed system, Saul-Edwards says. The Academy is lobbying against the new RBPE proposal, which...

Family Practice Management : News Briefs

https://www.aafp.org/fpm/1998/0700/p27.html

The New AMA President Answers Your Questions -- FPM

Jun 1, 1998 - Doctors and patients must make hard choices or face the dark ages of medicine, warns family physician Nancy Dickey, MD.

Family Practice Management : Articles

https://www.aafp.org/fpm/1998/0600/p25.html

Coding and Documentation Made Easier -- FPM

Apr 1, 1998 - The author's physician-friendly tool can help you to code more confidently.

Family Practice Management : Articles

https://www.aafp.org/fpm/1998/0400/p19.html

99213 or 99214? Three Tips for Navigating the Coding Conundrum

...99213 or 99214? Three Tips for Navigating the Coding Conundrum Here’s how to quickly identify whether you’re on the path to a 99214 versus a 99213. ABOUT THE AUTHOR Richelle Marting is an attorney practicing with Forbes Law Group in Overland Park, Kan., where she focuses on...

Family Practice Management

https://www.aafp.org/fpm/2018/0700/fpm20180700p5.pdf

Coding "Routine" Office visits: 99213 or 99214? -- Family Practice Management

...d ata show that family physicians choose 99213 for about 61 percent of visits with established Medicare patients and choose 99214 only about 23 percent of the time for the same type of visit.1 So 99213 must be the correct code to use for a routine visit, right? Not necessarily. Many...

Family Practice Management

https://www.aafp.org/fpm/2005/0900/fpm20050900p52.pdf

Browse FPM Documents on Topic: org.aafp.jms.model.TaxonomyTerm@25f6a65a

...Coding "Routine" Office Visits: 99213 or 99214? [Feature] Before choosing 99213 for routine visits, consider whether your work qualifies for a 99214. Oct 2004 Issue Understanding When to Use Modifier -25 [Getting Paid] A coding expert explains how and why modifier -25...

Family Practice Management

https://www.aafp.org/fpm/viewRelatedDocumentsByTaxonomy.htm?taxonomyId=27&page=2

Browse FPM Documents on Topic: org.aafp.jms.model.TaxonomyTerm@2d7767ac

...99213 or 99214? Three Tips for Navigating the Coding Conundrum [Feature] Here’s how to quickly identify whether you’re on the path to a 99214 versus a 99213. November/December 2014 Issue When Is It Right to Code 99215? [Feature] Knowing the rules will give you the...

Family Practice Management

https://www.aafp.org/fpm/viewRelatedDocumentsByTaxonomy.htm?taxonomyId=53

Browse FPM Documents on Topic: org.aafp.jms.model.TaxonomyTerm@e2aa06b

...99213 or 99214? Three Tips for Navigating the Coding Conundrum [Feature] Here’s how to quickly identify whether you’re on the path to a 99214 versus a 99213. November/December 2014 Issue When Is It Right to Code 99215? [Feature] Knowing the rules will give you the...

Family Practice Management

https://www.aafp.org/fpm/viewRelatedDocumentsByTaxonomy.htm?taxonomyId=53&page=0

Browse FPM Documents on Topic: org.aafp.jms.model.TaxonomyTerm@55b40e84

...99213 or 99214? Three Tips for Navigating the Coding Conundrum [Feature] Here’s how to quickly identify whether you’re on the path to a 99214 versus a 99213. Nov-Dec 2008 Issue Time Is on Your Side: Coding on the Basis of Time [Feature] E/M coding can be so complex...

Family Practice Management

https://www.aafp.org/fpm/viewRelatedDocumentsByTaxonomy.htm?taxonomyId=77

Browse FPM Documents on Topic: org.aafp.jms.model.TaxonomyTerm@7e958908

...Coding "Routine" Office Visits: 99213 or 99214? [Feature] Before choosing 99213 for routine visits, consider whether your work qualifies for a 99214. Jun 2005 Issue Are You Prepared to Defend Your Coding? [Getting Paid] The authors offer readers an action plan to use...

Family Practice Management

https://www.aafp.org/fpm/viewRelatedDocumentsByTaxonomy.htm?taxonomyId=75

July/August 2018

...99213 or 99214? Three Tips for Navigating the Coding Conundrum Richelle Marting How to Create a Culture of Well-Being in Your Practice Mark H. Greenawald Patient Inducements: The New Dos and Don'ts Alice G. Gosfield Teach-Back: A Simple Technique to Enhance...

Family Practice Management

https://www.aafp.org/fpm/2018/0700/

July/August 2018

...99213 or 99214? Three Tips for Navigating the Coding Conundrum Richelle Marting How to Create a Culture of Well-Being in Your Practice Mark H. Greenawald Patient Inducements: The New Dos and Don'ts Alice G. Gosfield Teach-Back: A Simple Technique to Enhance...

Family Practice Management

https://www.aafp.org/fpm/2018/0700

Sep 2005

...Coding "Routine" Office Visits: 99213 or 99214? Peter R. Jensen Departments From the Editor New and Improved for You Leigh Ann Backer Editorial Ten Hard Questions About the Future of the Specialty Douglas Iliff Letters • Taking Care of Children • Is...

Family Practice Management

https://www.aafp.org/fpm/2005/0900/

Sep 2005

...Coding "Routine" Office Visits: 99213 or 99214? Peter R. Jensen Departments From the Editor New and Improved for You Leigh Ann Backer Editorial Ten Hard Questions About the Future of the Specialty Douglas Iliff Letters • Taking Care of Children • Is...

Family Practice Management

https://www.aafp.org/fpm/2005/0900

fpm20070100p21.pdf

...(99213) visits - differences that can have a surprisingly significant effect on your bottom line if you don’t understand them well. For example, the 2007 Medicare allowance (not adjusted for geographic differentials) for a 99212 is $37.14, while the allowance for a 99213 is $59.50....

Family Practice Management

https://www.aafp.org/fpm/2007/0100/fpm20070100p21.pdf

fpm20160500p30.pdf

...For example, the report shows that Physician A reports code 99213 almost three times as often as code 99214, although the benchmark ratio is 1.08:1. There are no Medicare wellness visits or transitional care management services reported. There are no smoking cessation services or...

Family Practice Management

https://www.aafp.org/fpm/2016/0500/fpm20160500p30.pdf

Coding Better for Better Reimbursement -- Family Practice Management

...99212 and 99213. The CPT require- ments for these two codes are shown side by side on page 33. As you can see, the differ- ence between the two can be slight.If you don’t fully document the work you do in a visit, you’ll often end up coding 99212s for visits that are easily 99213s....

Family Practice Management

https://www.aafp.org/fpm/2003/0100/fpm20030100p29.pdf

fpm20110900p33.pdf

...status of chronic diseases). A brief HPI includes documentation of one to three of these elements and is consistent with E/M codes 99212 and 99213. Since this is a follow-up visit for well-controlled chronic condi- tions, the HPI doesn’t meet the level of an extended HPI, which...

Family Practice Management

https://www.aafp.org/fpm/2011/0900/fpm20110900p33.pdf

Test Your Coding Skills -- Family Practice Management

...Progress note 1 Reviewers’ recommendations: 9939x-25 + 11200 or 99213-25 + 11200 or 99214-25 + 11200 For this visit, three reviewers recommended one of the preven- tive medicine services codes 99391-99397 (determined by the patient’s age, which is not included in this note), 11200...

Family Practice Management

https://www.aafp.org/fpm/2002/0200/fpm20020200p41.pdf

fpm20110300p31.pdf

...Stuck on 99213 Selecting and documenting appropriate levels of E/M services can be challenging for many physicians. Often, code 99213 becomes the default code because physicians think exten- sive documentation will be needed for coding anything higher and they believe 99213 is...

Family Practice Management

https://www.aafp.org/fpm/2011/0300/fpm20110300p31.pdf

AAFP Comments to CMS on CY 2021 Medicare Physician Fee Schedule Interim Final Rules - ...

AAFP comment to CMS on priorities to consider for the 2021 Medicare Physician Fee Schedule Interim Final Rule.

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/feesched/LT-CMS-CommentsCY2021MPFSInterim-012921.pdf

AAFP Comments to CMS on the 2022 Medicare Physician Fee Schedule Proposed Rule - ...

The AAFP submitted detailed comments in response to the CY 2022 Medicare Physician Fee Schedule and Quality Payment Program proposed rule. Key issues include: fair valuation and payment for primary care services, facilitating the transition to value-based care, reducing administrative ...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/feesched/LT-CMS-MedicarePhysicianFeeScheduleProposedRule-091021.pdf

fpm20070400p39.pdf

...percent of established patient visits were reported as 99212 - a decrease of almost 50 percent. During the same four-year period, the use of 99213 decreased by about 7 percent and the use of 99214 increased by about 60 percent. The increased use of electronic health records...

Family Practice Management

https://www.aafp.org/fpm/2007/0400/fpm20070400p39.pdf

fpm20081100p22.pdf

...Take a look at From the presenting problem to the code on page 24. The tables show how the requirements for 99213-99215 and 99203-99205 look if you start from the presenting problem, assume that the other decision- making requirements are met and work toward the exam Coding From...

Family Practice Management

https://www.aafp.org/fpm/2008/1100/fpm20081100p22.pdf

fpm20041000p31-rt1.xls

...99213 Level 3 office visit, est 2269 $51.63 $65 126% $58 112% $62 120% 99232 Subsequent hospital care 596 $54.27 $65 120% $60 111% $65 120% 99214 Level 4 office visit, est 1977 $80.65 $100 124% $90 112% $97 120% 45330 Sigmoidoscopy 112 $117.28 $125 107% $125 107% $141...

Family Practice Management

https://www.aafp.org/fpm/2004/1000/fpm20041000p31-rt1.xls

Family Practice Management

...1 BAN 5/8/08 99213 None Office visit 99213 $85 None $85 No Charge never entered 2 JAl 5/8/08 Not found None New patient visit, quick strep test 99203 87880 $128 None $128 No lost superbill 3 BAN 5/8/08 99396 82270 90718 Same Same, plus vaccine administration...

Family Practice Management

https://www.aafp.org/fpm/2009/0300/fpm20090300p15.pdf

Why It’s Time to Purchase an Electronic Health Record System -- Family Practice Management

...group, docu- mented a substantial overall increase in the appropriate use of 99214 codes for visits that would previously have been coded 99213, approximately one year after implementing E L E C T R O N I C R E C O R D S You can use the worksheet below to estimate the net...

Family Practice Management

https://www.aafp.org/fpm/2004/1100/fpm20041100p43.pdf

fpm20091100p18.pdf

...• 99211, 2.14 percent • 99212, 14.89 percent • 99213, 66.13 percent • 99214, 15.79 percent • 99215, 1.04 percent 10 Steps to a Patient-Centered Medical Home AnTon J. Kuzel, MD, MHPe Downloaded from the Family Practice Management Web site at www.aafp.org/fpm. Copyright© 2009...

Family Practice Management

https://www.aafp.org/fpm/2009/1100/fpm20091100p18.pdf

fpm20041100p43-rt1.xls

...Current Medicare payment for 99213 in your area (e.g. $47.08): B $0.00 Additional income per 99214 visit (A - B) C $0.00 Current annual number of visits coded 99213: D 0 Additional visits coded 99214 with improved coding (0.1 x D): E 0 Estimated increase in revenue...

Family Practice Management

https://www.aafp.org/fpm/2004/1100/fpm20041100p43-rt1.xls

Outpatient E/M Coding Simplified

...Low complexity medical decision mak- ing: Codes 99203 and 99213 include two or more self-limited or minor problems, one If a test is ordered, the review of that test is included with the ordering, even if the review is done at a subsequent visit. KEY POINTS • The revisions...

Family Practice Management

https://www.aafp.org/fpm/2022/0100/fpm20220100p26.pdf

Combining a Wellness Visit With a Problem-Oriented Visit: a Coding Guide

...In many cases, a 99213 or 99214 can be billed with a Medicare wellness visit or preventive medicine visit as long as the phy- sician or billing clinician documents the extra work done for the evaluation and management service. (If patients are sick enough to justify a 99215, it’s...

Family Practice Management

https://www.aafp.org/fpm/2022/0100/fpm20220100p15.pdf

COVID-Town-Hall-032520.pdf

...Is code 99213 the correct billing code for a telemedicine visit? That is correct if you are using live video AND your billing documentation has the Place of Service code of 02. Is the AAFP doing anything to improve reimbursement for telemedicine visits? The AAFP is...

https://www.aafp.org/dam/brand/aafp/news/2020-september/documents/COVID-Town-Hall-032520.pdf

Time is of the Essence: Coding on the Basis of Time for Physician Services -- Family ...

...are summarized on page 30. For example, according to CPT, a 99203 office visit typically requires 30 min- utes of a physician’s time, while a 99213 office visit requires 15 minutes on average. When time can be used as the basis for selecting the right code, there is some debate...

Family Practice Management

https://www.aafp.org/fpm/2003/0600/fpm20030600p27.pdf

Making Sense of Preventive Medicine Coding -- Family Practice Management

...99213-25* Office outpatient E/M service for established patient 93000 Electrocardiogram 71020 Chest X-ray, PA and lateral *The level of service represents only an example. The level reported should be determined by the documented history, exam and/or medical decision...

Family Practice Management

https://www.aafp.org/fpm/2004/0400/fpm20040400p49.pdf

fpm20080200p36.pdf

...the same amount for a 99213. Other payers use multiple conversion factors, which means that physicians in dif- ferent specialties could be paid differently for performing the same service (see Are Your Payers’ Fee Schedules Fair? FPM, April 2007). Code: 99213 Work RVUs: 0.92...

Family Practice Management

https://www.aafp.org/fpm/2008/0200/fpm20080200p36.pdf

fpm20081100p17.pdf

...the physician spends at least 15 minutes of face-to-face time with the patient and the majority of that time involves counseling, then code 99213 could be reported (since 15 minutes is the typical time associated with that code). In contrast, using the key components to determine...

Family Practice Management

https://www.aafp.org/fpm/2008/1100/fpm20081100p17.pdf

fpm20090300p15-rt1.xls

...1 BAN 5/7/12 99213 None Office visit 99213 $ 95 None $ 95 Physician queried on diagnosis; no response or follow up; past filing limit. 2 JAL 5/7/12 Not found None New patient visit, quick strep test 99203 87880 $ 144 None $ 144 Services provided but charge not entered. No follow...

Family Practice Management

https://www.aafp.org/fpm/2009/0300/fpm20090300p15-rt1.xls

Family Practice Management

...A brief HPI limits the level of history to problem focused or expanded problem focused, and that limits the level of a follow-up visit to 99213 unless both the exam and the medical decision making are involved enough to justify a higher level without reference to the history. To...

Family Practice Management

https://www.aafp.org/fpm/2010/0300/fpm20100300p22.pdf

Countdown to the E/M Coding Changes

...Level 3 99213 20-29 minutes 99203 30-44 minutes Level 4 99214 30-39 minutes 99204 45-59 minutes Level 5 99215 40-54 minutes 99205 60-74 minutes 99417 x 1 + 99215 55-69 minutes + 99205 75-89 minutes 99417 x 2 + 99215 70-84 minutes + 99205 90-104 minutes 99417 x 3 (or...

Family Practice Management

https://www.aafp.org/fpm/2020/0900/fpm20200900p29.pdf

Coding Level 4 Office Visits Using the New E/M Guidelines

...99203 99213 Low Low • 2 or more self-limited or minor problems or • 1 stable chronic illness or • 1 acute, uncomplicated illness or injury Limited (Must meet the requirements of at least 1 of the 2 categories) Category 1: Tests and documents Any combination of 2 from the...

Family Practice Management

https://www.aafp.org/fpm/2021/0100/fpm20210100p27.pdf

AAFP Letter to CMS Requesting Codes to be Added to the "Primary Care Exemption" List - ...

...• 99201, 99202, 99203 - New patient visits • 99211, 99212, 99213 - Follow-up patient visits • G0402, G0438, G0439 - Welcome to Medicare and Annual Wellness Visits With the proliferation of new screening and preventive care services, the AAFP believes more can be done to promote...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-PrimaryCareExemption-100919.pdf

COVID-19-Town%20Hall-QA-041520.pdf

...Is Medicare also covering E/M codes 99213-99215 for audio-only services? No. Medicare currently requires real-time audio and video to report office/outpatient E/M codes, such as 99213-99215 as telehealth services. Is Medicare covering audio-only services for FQHC's?...

https://www.aafp.org/dam/brand/aafp/news/2020-september/documents/COVID-19-Town%20Hall-QA-041520.pdf

Americans in Motion - Healthy Interventions: A Guide to Group Visits for Chronic ...

Research indicates group visits can also provide an improved quality of care and a higher level of patient and physician satisfaction. They empower patients and also the physician and staff. Group visits allow for more time for education and relationship building. Group visits have ...

Patient Care

https://www.aafp.org/dam/AAFP/documents/patient_care/fitness/GroupVisitAIM.pdf

How to Get All the 99214s You Deserve -- Family Practice Management

...99211 99212 99213 99214 99215 CC N/A Required Required Required Required HPI N/A 1-3 elements 1-3 elements 4+ elements 4+ elements (or 3+ chronic (or 3+ chronic diseases) diseases) ROS N/A N/A Pertinent 2-9 systems 10+ systems PFSH N/A N/A N/A 1 element 2 elements...

Family Practice Management

https://www.aafp.org/fpm/2001/1000/fpm20011000p43.pdf

fpm20020700p20-rt1.xls

...99213 OV,Est.,Low-Expanded 475 20.14% 2046 76.72% 1542 74.96% 4063 57.36% 40.92% 99214 OV,Est.,Moderate-Detailed 125 5.30% 224 8.40% 128 6.22% 477 6.73% 51.70% 99215 OV,Est.,High-Comp. 36 1.53% 24 0.90% 28 1.36% 88 1.24% 2.98% Totals 2359 100.00% 2667 100.00% 2057...

Family Practice Management

https://www.aafp.org/fpm/2002/0700/fpm20020700p20-rt1.xls

How to Get All the99214s You Deserve -- Family Practice Management

...99211 99212 99213 99214 99215 CC N/A Required Required Required Required HPI N/A 1-3 elements 1-3 elements 4+ elements 4+ elements (or 3+ chronic (or 3+ chronic diseases)2 diseases)2 ROS N/A N/A Pertinent 2-9 systems 10+ systems PFSH N/A N/A N/A 1 element 2 elements...

Family Practice Management

https://www.aafp.org/fpm/2003/1000/fpm20031000p31.pdf

Group Visits Hit the Road -- Family Practice Management

...10 99213-level visits (I didn’t bill for the three seniors who had other physicians). It is impor- tant to note, though, that although I was reimbursed for the codes I submitted, this may not be the case with all payers. In fact, the CPT Editorial Panel gives different advice,...

Family Practice Management

https://www.aafp.org/fpm/2004/0900/fpm20040900p39.pdf

fpm20080500p19-rt1.xls

...1.57 99213 $59.80 $53.46 -$6.34 2.38 99214 $90.65 $81.04 -$9.61 3.22 99215 $122.64 $109.64 -$13.00 Initial hospital 2.23 99221 $84.93 $75.93 -$9.00 3.13 99222 $119.21 $106.58 -$12.64 4.57 99223 $174.06 $155.61 -$18.45 Subsequent hospital 0.94 99231...

Family Practice Management

https://www.aafp.org/fpm/2008/0500/fpm20080500p19-rt1.xls

fpm20130700p23.pdf

...CPT code: 99213 for an established patient or 99202 for a new patient. Diagnosis: 307.81 (tension headache). Concerns. Documentation does not indicate whether this is a new or established patient. This detail should be included in a heading or in the body of the note so that...

Family Practice Management

https://www.aafp.org/fpm/2013/0700/fpm20130700p23.pdf

Opting Out of Medicare: How to Get Out and Stay Out

...Established Patient E/M ChartLevel 1 Level 2 Level 3 Level 4 Level 5 Office/OP 99211 (5 min) 99212 (10 min) 99213 (15 min) 99214 (25 min) 99215 (40 min) -OR- See below for billing by time factor. 1995 Basic Evaluation and Management Codes Coding Reference Card Evaluation and...

Family Practice Management

https://www.aafp.org/fpm/2017/1100/fpm20171100p17.pdf

The 2021 Office Visit Coding Changes: Putting the Pieces Together

...CPT code: 99213 Explanation: Under the 2021 guidelines, low-level MDM involves at least two of the following: • Low number and complexity of prob- lems addressed at the encounter, • Limited amount and/or complexity of data to be reviewed and analyzed, • Low risk of...

Family Practice Management

https://www.aafp.org/fpm/2020/1100/fpm20201100p6.pdf

How to Integrate Clinical Pharmacists Into Primary Care

...Reimbursement commensurate with these efforts is available. A single visit could warrant code 99213 or 99214 (depend- ing on time or visit complexity), 94664 for demonstration or evaluation of patient utilization of a metered dose inhaler, and 99407 for smoking and tobacco use...

Family Practice Management

https://www.aafp.org/fpm/2021/0500/fpm20210500p12.pdf

Coding Outpatient E/M Visits

...99213 Time based: 20-29 minutes 99203 Time based: 30-44 minutes Low complexity medical decision making (need 2 of 3): Problems Data (1 of 2 needed) Risk • 2 or more self-limited or minor problems or • 1 stable chronic illness or • 1 acute uncomplicated illness...

Family Practice Management

https://www.aafp.org/fpm/2022/0100/fpm20220100p26-rt1.pdf

NEWS NOW

...and Medicaid Services’ (CMS’) final 2011 Medicare conversion factor, the average payment rate for current procedural termi- nology (CPT) code 99213-commonly used by family physicians-will increase this year even though the numeric value of the conversion factor has been reduced. As...

American Family Physician

https://www.aafp.org/afp/2011/0201/afp20110201p239.pdf

AHRQ’s Tools for Better Practice: Helping Family Physicians Manage Today’s Challenges

November 1, 2017: Editorials

American Family Physician

https://www.aafp.org/afp/2017/1101/afp20171101p569.pdf

fpm20060700p20-rt1.xls

...1.39 1.57 99213 $52.67 $59.50 $6.82 2.18 2.38 99214 $82.61 $90.19 $7.58 3.17 3.22 99215 $120.13 $122.02 $1.89 Initial hospital 1.80 2.23 99221 $68.21 $84.51 $16.29 2.98 3.13 99222 $112.93 $118.61 $5.68 4.15 4.57 99223 $157.26 $173.18 $15.92 Subsequent...

Family Practice Management

https://www.aafp.org/fpm/2006/0700/fpm20060700p20-rt1.xls

fpm20070400p39-rt1.xls

...99213 OV,Est.,Low-Expanded 475 20.14% 2046 76.72% 1542 74.96% 4063 57.36% 48.19% 99214 OV,Est.,Moderate-Detailed 125 5.30% 224 8.40% 128 6.22% 477 6.73% 40.23% 99215 OV,Est.,High-Comp. 36 1.53% 24 0.90% 28 1.36% 88 1.24% 3.56% Totals 2359 100.00% 2667 100.00% 2057...

Family Practice Management

https://www.aafp.org/fpm/2007/0400/fpm20070400p39-rt1.xls

Skin Care Encounter Form

...99213 Expanded problem focused 95044 Patch tests _____________ # of tests 99214 Detailed 11102 Tangential skin biopsy, single 99215 Comprehensive [ ] Procedure only +11103 Tangential biopsy, each add’l (#)______ 99024 Post-op care 11104 Punch skin biopsy, single New...

Family Practice Management

https://www.aafp.org/fpm/2013/0100/fpm20130100p11-rt1.pdf

AAFP Comment Letter on 2019 Final Medicare Physician Fee Schedule - December 28, 2018

...and that the physician personally spent the current typical time for the CPT code reported (e.g., 15 minutes when reporting CPT code 99213). We support this plan and strongly urge CMS to implement it in 2020. This is the same approach now used when physicians code based on time...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/coverage/medicare/LT-CMS-2019FinalMPFS-122818.pdf

AAFP Letter to CMS with Final Comments on the 2019 Proposed Medicare Physician Fee ...

...patient office visit in counseling/coordination of care and chooses to code on the basis of time, the physician should select code 99213 (typical time of 15 minutes) rather than 99214 (typical time of 25 minutes), because the total time of the encounter did not reach the threshold...

Advocacy

https://www.aafp.org/dam/AAFP/documents/advocacy/payment/medicare/LT-CMS-2019ProposedMPFS-090618.pdf

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