CPT 99203 through CPT 99215 - New Patient Consult Billing Codes versus Follow Up Codes
Summary:
Learn the difference between cpt 99203, 99204, 99205, and 99202. Full descriptions and pictures on how iVECoder would help you decipher initial new patient consult codes versus established patient codes are supplied. Remain in compliance, get paid faster, and stay out of those federal audits leading to ugly orange jump suits.
What is CPT Code 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 time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
Did you know?
CPT 99203 is one of the nation's top 10 leading codes used in error? Many times clinics will use 99203 in error when they should select 99213 for a follow up. If your clinic has seen the patient within the last three years, the patient is not a "new consult", but rather a follow-up.
99203 CPT Description in Layperson's Terms
If you're a new medical biller or medical coder, or you're also running the practice, the language and jargon used by the AMA and CMS can be overwhelming at times. That's why iVECoder provider "laymen's terms" for every code researched.
CPT 99203 Description in laymen's terms is, "New patient office or other outpatient visit, 30-44 minutes."
Current CMS Status of CPT 99203: Active Code
These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.
CPT 99203 Global Period has a no status for Pre-Op and Post-Ops Days. You want to verify with your current payer contracts to see if exclusions are applied.
CPT 99203 CMS Adjustments will be 0% Pre-Op, 0% Intra-Op, and 0% Post-Op.
General Information about CPT Code 99203
There is no endoscopy base, cpt 99203 has a diagnostic family of 99, no specific age or sex qualifications, a therapeutic D/X of C, no Costmetic, MUE count per CMS is 1, and HOS MUE Count per CMS is 1.
When you search CPT 99203 in iVECoder you will find the ability to quickly search any HCPCS. In this case study we typed in 99203 at the top. You can see that it supplies not just 99203 cpt but also the codes prior and following, with cms short descriptions, cms long descriptions, when it became effective, and any possible termination dates.
Flags for Billing CPT Code 99203
- No duplicates for cpt 99203
- No authorization required for cpt 99203
- No experimental for cpt 99203
- No Medicare Non-Payable for cpt 99203
- No Non-Facility Only for cpt 99203
- No Medicaid Assistant for cpt 99203
- No Medicaid Non-Payable for cpt 99203
- No Inpatient for cpt 99203 (outpatient only)
GPCI for Correct Financial Details for Each Claim with cpt 99203
In iVECoder you can also configure your GPCI and overall settings to see information like the clinic we set up in Nevada. Additionally, you can change your GPCI with the button below to run cpt 99203 based on other states and regions to see if financial details change. Research 99203 and find the Non-Facility and Facility collections based on the GPCI codes you use with your AI medical coding software.
Avoid CPT 99203 - 99205 Audits and Increase Your Compliance
When you have an AI coding research tool you can also find out specifics about each codes and avoid audits and increase your compliance.
Example: Dr. Smith’s sees 20 new patients per day, but his coder Incorrectly codes for 99203. If you’re audited, you better be able to showcase a consistent 10-hour work day because 99203 is for 30-44 min. A cleaner trend of billing outpatient consults is a combination of 99202 - 99205. It shows that as a provider you are spending the amount of time needed per patient. It also shows that you are not just auto-choosing your codes.
Identify CPT 99211 - CPT 99218 for Follow-Ups
As you look further down the associated codes, you also find important descriptions like 99214 is an office patient for an established patient. One of the fastest ways to get audited and face adjustments and penalties is to bill a 99203 for an established patient who underwent some inpatient hospital procedure.
Summary of CPT 99202 and Initial Consult Coding
Understanding every CPT code ranging from 99203 - 99218 can be time consuming, and let’s be honest… there’s over 68,000 medical codes. While we hope you found this information helpful, why not throw away those coding books and let AI help you find the exact code(s) that can be approved the first time. If you’re interested in a FREE Trial just click the link below or email us at info@pcgsoftware.com
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Will Schmidt joined PCG Software as their Chief Strategy Officer in November 2022. Prior to PCG, Schmidt lead TNH as their Sr. Vice President to become the 7th largest pharmacy in the nation. He then went on to consult with and serve as Interim CEO or Consultant to over 20 different companies specializing in profit strategies, operational efficiencies, vendor relations and partnerships, and exit strategies, include an international Revenue Cycle Management Company.
