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99213

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News & Trends - May 2006 -- FPM

May 1, 2006 - ...billed by family physicians and should pay for them fairly. Recently, Anthem of Southern Ohio announced it would begin reimbursing codes 99213 and 99214 at a blended rate. In an April 7 letter, AAFP Board Chair Mary Frank, MD, justified the increase in high-level E/M codes, noting...

Family Practice Management : News Briefs

https://www.aafp.org/fpm/2006/0500/p26.html

Coding & Documentation - Feb 2006 -- FPM

Feb 1, 2006 - ...for a separately identifiable service on the same date as an E/M service, the modifier −25 should be appended to the E/M code (for instance, 99213-25.) Payers may choose to bundle code 99173 with the E/M service despite the correct modifier usage. You should check with your payer to...

Family Practice Management : Coding & Documentation

https://www.aafp.org/fpm/2006/0200/p30.html

How Do You Cope With Bundled Claims? -- FPM

Apr 1, 2006 - Don’t cheat yourself. That’s the health plan’s job.

Family Practice Management : From the Editor

https://www.aafp.org/fpm/2006/0400/p14.html

ICD-9 Changes: It's Time to Tend to Your Superbill -- FPM

Sep 1, 2005 - You’ve got until Oct. 1 to weed out incorrect codes.

Family Practice Management : Articles

https://www.aafp.org/fpm/2005/0900/p49.html

Meet Dr. Wonderful -- FPM

Sep 1, 2005 - This doll tells people exactly what they want to hear.

Family Practice Management : The Last Word

https://www.aafp.org/fpm/2005/0900/p68.html

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

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

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 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

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

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

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

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

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

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

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

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

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

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

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...

Family Practice Management

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

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 up....

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 99XXX x 1 + 99215 55-69 minutes + 99205 75-89 minutes 99XXX x 2 + 99215 70-84 minutes + 99205 90-104 minutes 99XXX x 3 (or...

Family Practice Management

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

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 Nov-Dec...

Family Practice Management : Coding & Documentation

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

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

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