Current Procedural Terminology codes describe the services provided to your patients from exams, therapy, X-ray, etc. CPT codes can change dramatically some years – like in 2021, which featured a complete revamp of evaluation and management services (E&M). Let’s review the code changes for 2024 (which also include an E&M update).
Billing Based on Time
Office visit codes 99202-99205 and 99212-99215 have been revised to remove the time “range” in minutes from each code. Instead, billing based on time requires a single “minimum time threshold” to meet or exceed. This revision now indicates the minimum time that must be completed or exceeded.
For example, 99202 now indicates that the minimum time that must be met or exceeded is 15 minutes, rather than the previous range of 15-29 minutes. This makes it more clear that the minimum time is needed. Note that the time is not just face to face, but also activities that are part of the exam – which could be before or after the face-to-face time with the patient.
Here are the descriptions of all the office visit codes. Of special note, there is of course no longer code 99201, with 99202 being the lowest level for a new patient. In addition, 99211 for an established patient did not change and has no time component. Again, each code now simply indicates the minimum time that must be met or exceeded.
Codes 99202-99205
99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision-making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision-making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision-making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
Codes 99212-99215
(Remember, 99211 did not change: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.)
99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical-decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision-making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision-making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
Other Considerations
If you are using time to choose E&M services, it is imperative to document the specific time in the notes. If code choice is by medical decision-making, it need not meet the minimum time. However, often the more complex will meet the time.
There are no changes to spinal and extraspinal CMT services in description; but be aware to choose the code based on the diagnosis and regions adjusted, not just by the technique or regions alone. To code a 98941, you must diagnose and adjust three spinal regions.
Physical medicine codes also have no changes in description. However, based on reviews by major carriers, doctor of chiropractic often are not documenting the timed services correctly, and is the #1 reason they are subject to review and repayment when not documented. Time follows the eight-minute rule and must be documented based on total minutes spent face to face or from and to time. Most carriers appear to prefer and want time documented in from and to time; for example, 9:15 to 9:35 for 20 minutes, instead of just indicating 20 minutes.
Editor’s Note: Have a billing question? Submit it via email to Sam at sam@hjrossnetwork.com. Your question may be the subject of a future column. Note that submission of a question is acknowledgment that it may be referenced (anonymously) in his column.
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