Medical Coding Guide: Understanding CPT 99213 vs 99214 Differences

Accurate medical coding can help your clinic to grow its finances effectively. Each code you assign matters, as you may face several claim denials due to a single coding mistake. Most of the time, you use CPT codes such as 99214 to document all patient visits. So, you can get paid on time and avoid all the unwanted audits by using the right codes. The important thing is that you can streamline your RCM process when you know how both of these codes differ and when to assign all of them correctly. Here, you can take the help of medical coding outsourcing services who can get you out of this hassle.  

Why There’s a Misconception Between CPT 99213 Versus CPT 99214?  

The codes differ in complexity, exact time spent, documentation, and reimbursement rates. The major differences range from meaning to physician examination needs.   

Differences in the Meaning  

The in-house team assigns CPT 99213 to all the established patients on a level 3 visit which includes fewer decision-making complexities. However, you need to use CPT 99214 to document all the level 4 office visits for all the established patients. This process makes sure that you get optimized payment for all medical judgments and services.  

Usage Times  

Always use CPT 99213 when the patient has a stable condition. Moreover, use the CPT 99214 code to document a patient visit for other important reasons. These reasons include adjusting uncontrolled hypertension or similar symptoms. However, the medical coding outsourcing services are experts in this process, which can streamline the claim submission process.  

Documentation Procedure  

Always document the patient’s problem-focused history in which you need to keep the patient’s record and a short description of the problem when using CPT 99213. On the other hand, CPT 99214 requires a detailed patient history. There is something called a 4*4 approach which you can follow. It means the need to cover four or more elements of the present patient’s illness history, reviewing around two to nine organ systems, and documenting only one element from the past family and social history of the patient.  

Exact Physician Examination Needs  

The reimbursement rate for CPT code 99213 is very low. You can get around $90-$95 based on the payer for a shorter patient visit duration. Moreover, you can work with utmost compliance by using the right codes for patient visits. On the other hand, the reimbursement rate is higher for CPT code 99214, which ranges from $126 to $148. Hence, the clinics can avoid underbilling issues and use the correct financial management for CPT code 99214 with proper education.  

How Do the Medical Coding Outsourcing Services Help?  

The outsourced companies avoid undercoding and upcoding, and they also use all the proper coding references. Let’s discuss how these services help:  

Avoid Undercoding and Upcoding  

You know that the higher-level codes like CPT 99214 need proper documentation support, but you may also face upcoding if you fail to provide the insurers with the right documentation. Undercoding happens in a different scenario where several low-level codes are assigned instead of the high-level codes. The outsourced experts are excellent at this process to reduce coding-related issues.  

Recording Care Condition  

You need to record all the care coordination, like talking to different doctors and referrals, when you document 99214 visits. It is highly beneficial when you show moderate complexity in making decisions and supporting that decision with a higher-level code. This is what the outsourced companies are experts at.  

Don't Forget to Educate Your Staffs  

Always document the discussed topics when you educate your staff about all the claim denial reasons. However, proper documentation is helpful to support all time-based coding and make sure the billed service properly reflects the care provided. These third-party experts are brilliant in educating their staff about the latest coding nuances to make sure no issue occurs.  

End-to-End RCM Process  

These third-party experts make sure to stay updated with all the latest CPT, ICD, and HCPCS codes to protect patient data. Moreover, they also don’t need any separate office space as the outsourced companies provide them with that, which reduces the clinic’s cost massively. In addition to that, these experts know how to use the EHR process to store patient data and the Electronic Prior Authorization (ePA) procedure to submit claims electronically. 

These outsourced companies can reduce your operational costs by 80% and work with 10% buffer resources to make sure no issue occurs. They also provide customized reports and the best infrastructure setup according to the client’s needs. These companies provide dedicated account managers and the best infrastructure setup to make sure no issue occurs. So, if you want to streamline your billing process, it can be a feasible option to take the help of medical coding outsourcing services in that matter. Hence, take the step today and see the difference.