Cpt 99214 - Getting the earnings You Deserve

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The Cpt code 99214, if used correctly, can be a great earnings enhancer for the provider. There are many providers who do not utilize this code to its fullest potential. By only using Cpt code 99212 and Cpt code 99213 many providers are losing thousands of dollars in legitimate earnings yearly. However, with the exact use of the Cpt code 99214 you can assure yourself the earnings that you rightly deserve.

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Insurances are Glad To Pay You Less

Medicare and other assurance associates are happy to pay the lesser amounts to providers if they (the providers) are willing to under-utilize the Cpt code 99214. The key to using this code properly is to understand the proper use and the components required to fully capture the maximum out of all of your encounters. As a provider, you will be rewarded the fruits of your labor when you take the time to learn the components of this code and use it properly.

When you reconsider Cpt code 99214 it has a higher return rate connected to it, however, it must fall under the purview of a moderate complexity to a high severity problem. The physician, if using time as a factor must have spent at least 25 minutes in a face to face scenario with the patient. However, the time component is only a guide and not wholly required if the components are included in the visit and the required curative necessity is present. The physician must be able to furnish the two or three areas which contain history, corporal exam and curative decision development with the proper documentation when filing for the Cpt code 99214.

The inpatient encounter, composed of a detailed history, detailed inpatient exam and moderate complexity in the curative decision development will interpret the use of Cpt code 99214 as long as the curative necessity is apparent.

Document, Document, Document

For example, you have an established office inpatient with hypertension, diabetes and a history of dyslipidemia who you are looking on corollary up in the office. Under the 1997 guidelines you can use three lasting and stable conditions to qualify for the higher code within the history component.

Document the medications and the relate of systems along with the proper past medical, house and public history and the first component is met. Document the proper corporal exam using acceptable organ system arrival six areas with two bullets each and you have met the requirement for the complexity on this area.

At this point, technically you have reached the level 4 criteria since there only needs to be two out of three components required for an established patient.

However, we feel that it is difficult to not have a curative decision development component so we contain that into our progress note. You can document the lab results for the inpatient and added solidify the visit to qualify at the higher code. As long as the curative necessity is present to interpret the work done during the visit the coding can be at the higher level.

Most providers will code the example as a Cpt 99213, however, the qualifiers are present for the higher 99214 code.

That being said, evaluating three different curative problems such as Hypertension, Diabetes and Hyperlipidemia, using the 1997 rules, you have met the curative necessity component as well, due to the need to monitor these diseases and help the inpatient with his/her control.

Taking the time to learn the proper criteria needed to code the encounter will enable you to reap the rewards for the rest of your career. In a day and age where we are facing potential cuts in the reimbursements for the services we render, we owe it to ourselves to stop giving away the earnings we deserve. The moment you have mastered the art of the using the proper Cpt codes you will be able to narrative them accurately and get the money you deserve.

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