CPT Code 99202: New Patient Office or Other Outpatient Services, Level 2
In this quick reference guide to CPT code 99202, we answer frequently asked questions from our community of chiropractors. Follow us for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors.
This comprehensive guide to CPT code 99202 provides chiropractors with essential information for accurate and efficient coding and billing. Familiarize yourself with the details below to ensure proper usage of this code in your practice.
About CPT Code 99202: New Patient Office or Other Outpatient Services, Problem Focused, Minor Severity
CPT code 99202 pertains to a new patient office or other outpatient visit for evaluation and management (E/M) services at a level 2 complexity. This involves three key components:
- Detailed history taking. Gathering comprehensive information about the patient’s current health concerns and relevant past medical history.
- Detailed examination. Conducting a thorough physical examination that encompasses the identified problems and includes any necessary chiropractic tests or maneuvers.
- Moderate medical decision-making. Making decisions about diagnosis, treatment plans, and prognosis based on the gathered information.
If these aren’t part of the visit, use a different code.
Category or Type of Service
CPT code 99202 falls under the category of Evaluation and Management (E/M) services. As a level 2 E/M service, it is designed for new patients, indicating that the patient has not been seen by the provider or a provider in the same specialty within the same practice within the past three years.
This code is typically billed per encounter and is intended for visits of moderate complexity, typically lasting between 20-29 minutes. For less complex encounters, consider using code 99201. For higher-complexity encounters, explore codes 99203, 99204, or 99205.
When Should Chiropractors Use This Code?
Chiropractors should employ CPT code 99202 for new patient office or other outpatient visits meeting the following criteria:
- A detailed history taken down.
- A thorough physical exam that may include specific tests of maneuvers.
- Decisions about diagnosis and treatment plans based on the history and exam.
Consider both time and complexity when deciding between 99202 and other E/M codes, with complexity being the more critical factor.
When Should Chiropractors Not Use This Code?
Chiropractors should avoid using CPT code 99202 for:
- Established patient visits. This code is specifically for new patients; established patient visits should be coded appropriately based on complexity.
- Chiropractic manipulative treatment (CMT) sessions. CMT is a distinct service and should be billed separately unless the E/M service is significantly separate and identifiable.
- Extensive discussions or counseling. If the visit primarily involves lengthy discussions about lifestyle modifications, pain management strategies, or chronic disease management, consider a code suitable for counseling and cognitive services.
If a patient visit feels like this code fits, but not quite, review other codes in this group and see if they’re a better fit.
Which Modifiers Can Be Used With CPT Code 99202?
Chiropractors can use the following modifier codes with CPT code 99202:
- Modifier 25. Signifies that a separate and distinct E/M service was performed on the same day as another procedure or service.
- Modifier 59. Indicates that a procedure or service was distinct or independent from other services performed on the same day.
- Modifier AT. Signifies that a service or procedure was performed for an acute or chronic subluxation and must be used for 99202 encounters billed to Medicare.
- Modifier 95. Signifies that the E/M service was delivered via interactive audio-video telecommunications technology.
- Modifier GT. Used for telehealth services, especially in cases where insurers haven’t universally accepted modifier 95.
Always check payer-specific guidelines when using modifiers to ensure accurate and compliant billing.
What Are the Billing Guidelines and Documentation Requirements Specific to This Code?
The following billing guidelines and documentation requirements apply to code 99202:
- Frequency of use. Verify with each patient’s insurance carrier to confirm billing frequency limits for this CPT and similar codes.
- New patient. Make sure there’s no established patient-provider relationship, as this code is exclusive to new patients.
- Face-to-face encounter. The provider must physically see the patient, either in person or via telehealth; over-the-phone services do not qualify.
- Care provided. Some evaluation and management of the new patient must occur during the visit, addressing a clinical need, providing care, and noting decision-making regarding the treatment plan.
- Separate billing. If additional chiropractic services are provided on the same day, 99202 must be billed as a separate charge using modifier 59.
Any documentation when billing 99202 must be clear, legible,specific and must demonstrate the degree of complexity.
What Are Examples of ICD-10-CM Codes Often Used With This Code?
Common ICD-10-CM codes used with CPT code 99202 include:
- Z01.1. Encounter for examination of ears and hearing.
- R05. Cough.
- M54.5. Low back pain.
These are just a few examples; always select the most accurate and specific diagnosis code based on the patient’s condition and clinical documentation.
What Are Common Mistakes Made Specific to CPT Code 99202?
Avoid these common mistakes when using CPT code 99202:
- Excessive use. Reserve this code for new patient E/M visits with detailed history, examination, and moderate complexity.
- Using it for an established patient visit. This code is exclusively for new patients.
- Relying solely on time. The complexity of E/M elements should be the primary determinant, not just the time spent.
- Treating it as a “catch-all” code. Reserve it for visits with detailed history taking, thorough examination, and moderate decision-making related to one or two key problems.
- Insufficient documentation. Use specific terminology and details that accurately reflect the level of complexity.
- Inconsistent documentation. Ensure your documentation consistently reflects the moderate level of E/M services provided.
- Misunderstanding payer policies. Review each payer’s policies to meet their expectations.
Review these before billing 99202, to make sure you’re within guidelines.
What Are Potential Audit Triggers Specific to This CPT Code?
Be aware of potential audit triggers for CPT code 99202, including:
- Inconsistent use of time. Billing 99202 consistently for all new patient visits, regardless of complexity, can raise suspicion.
- Lack of supporting documentation. Vague or incomplete documentation of history, examination, and medical decision-making can cast doubt on the justification for using 99202.
- Inadequate MDM complexity. If the documented MDM lacks complexity, it might not support a 99202 code.
- Billing for bundled services. Ensure you’re not billing for services already covered by 99202.
A review of the visit before billing helps avoid these audit triggers.
What Can I Do to Improve the Accuracy and Efficiency of My Practice’s Billing and Coding Processes?
Chiropractors can enhance the accuracy and efficiency of billing and coding by:
- Performing comprehensive audits. Regularly review billing and coding practices to identify and rectify errors.
- Staying up-to-date. Keep abreast of changes to billing and coding regulations.
- Using specialized software. Employ cloud-based EHR and practice management software designed for chiropractors, such as ChiroTouch, to streamline processes.
By following these guidelines and staying informed, chiropractors can optimize their billing and coding practices, ensuring compliance and accurate reimbursement for services provided.
To learn more about choosing the correct level for new patient office visits, read CPT Codes 99201-99205: New Patient Office or Other Outpatient Services.
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