Understanding the 99215 CPT Code Description: A Complete Guide for Healthcare Providers

If you are a healthcare provider, then you definitely need to get a better understanding of the codes that you can use in order to properly bill the services you provide. Your insurance provider will require you to file everything the right way if you are to get the reimbursement. One such code is the 99215 CPT, a critical evaluation and management (E/M) code. It deals with, well, evaluation and management of established patients in an office or an outpatient location. Go here to better understand outpatient visits.

To be in compliance with your insurance requirements, and to get the necessary reimbursement, you will have to better understand this code. You’ll have to know what it entails, how to use it, how to document and how to bill for it. And then, you may also be interested in knowing how to avoid denials, in case you’ve been facing those in the past.

Well, those are all, without a doubt, some rather important questions right there. So, what we are going to do right now is answer them for you, hoping to shed light on this particular code, and on the requirements for using it. Of course, we’ll also talk about the steps you should take to avoid denials, which is bound to be of help as well. Without any further ado, thus, let us start elucidating the entire concept.

What Is the 99215 CPT Code?

What is this code in the first place? Well, in short, it is a level 5 E/M code for those established patient visits. It signals that comprehensive evaluation has been done, as well as that high-complexity medical decisions have been made, or that the interaction with the patient has been extensive. What you are probably wondering right now is when it is actually used.

That’s a great question, and one that you absolutely need an answer to. When you read a detailed 99215 cpt code description, you will also understand when it is used, and anything else you need to know about this concept as a healthcare provider. To offer you the short answer, though, it is typically used when the patient has presents with severe or multiple conditions, when there is a need for an in-depth assessment, detailed diagnostic interpretation, and, of course, extensive treatment planning. In addition to that, if you engage in extensive counselling or care coordination, you will also be able to use this code.

What Are the Requirements for Using It?

Undeniably, though, there are some requirements that you need to be aware of and follow when looking to get properly reimbursed through this code. In short, to correctly bill, the patient visit has to meet at least two out of three critical components. First off, there is the patient history, and it has to be comprehensive, including not only the chief complaint, but also an extended history of present illnesses, as well as a detailed past family, medical, and social history.

Then, there is the examination criterion. To put it simply, you will need to have done a comprehensive physical examination. This can mean covering one organ system extensively, or examining multiple systems in the patient’s body.

The third criterions is high complexity medical decision making (MDM). Basically, to use this code, there have to be multiple diagnoses, or management options, as well as a high risk of complications, morbidity, or even mortality. In addition to all the criteria mentioned there, a lot of healthcare providers can now alternatively use total time spent on the visit as one of the determining factors. And, the total time has to be at least 40 minutes for you to be able to bill through this code.

How to Avoid Denials?

One of the main things that most healthcare providers are concerned about is getting their claims denies. This happens. But, if you know how to do everything the right way, you will have much higher chances of avoiding those denials. So, let me give you a better idea about how to avoid them, and how to, thus, do everything correctly.

Learn about medical billing in general: https://www.business.com/articles/medical-billing-process/

Well, first things first, you have to ensure the accuracy of your documentation, so remember to add all the necessary details about the medical history, the examination process, and the medical decision-making. Additionally, you should always do you best to use the proper modifiers, as well as confirm payer-specific guidelines, and those pre-authorization requirements. Don’t forget to document the total time when it is applicable. And, in the end, ensure that the actual visit justifies the level of the care billed.

One more thing. If all of this sounds too complex to you, as it often very much is, the best thing to do is work with professionals who will handle the billing and the claims on your behalf. When you have the right pros on your side, you are sure to avoid denials.