Healthcare practitioners are paying more attention to the particular requirements of older persons as our population ages. The medical field of geriatrics, which focuses on caring for older adults, offers a vast range of treatments and services. Healthcare professionals frequently rely on the CPT codes, a standardized system of codes, to guarantee that geriatric patients receive adequate and efficient care.
Healthcare providers may accurately bill insurance companies and other payers for their services thanks to CPT codes, which are used to record medical operations and services. Each year, new codes are introduced to this set of codes to reflect improvements in medical technology and adjustments in healthcare regulations.
CPT Codes: 99202 – 99205
- 99202: CPT code 99202 is used for simple medical decision-making and applicable history or examination. The encounter usually lasts 15–29 minutes. This corresponds to a level 2 office or outpatient visit.
- 99203: 99203 is the code for a visit that highlights a medically necessary history or examination but has very less medical decision-making. The encounter lasts at least 30 minutes, with 44 minutes being the absolute minimum for this code. This code corresponds to a level 3 office or outpatient visit.
- 99204: CPT code 99204 is used for visits requiring a medically essential history or examination and some medical decision-making. The encounters last for 45–59 minutes. CPT code 99204 corresponds to a level 4 office or outpatient visit.
- 99205: 99205 codes a complete medical history, physical exam, and high-level medical decision-making visit. The encounter lasts for 60–74 minutes. CPT code 99205 corresponds to a level 5 office or outpatient visit.
Also: CPT Codes for Physical Therapy
CPT Codes: 99211 – 99215
- 99211: This code highlights a simple physician-presence contact. It is used for simple tasks like getting a flu shot or changing a bandage and requires little examination or decision-making.
- 99212: A medically suitable history or examination and necessary medical decisions define this code. The Meetings last 10–19 minutes. Standard office visits and follow-ups use this code.
- 99213: This code highlights a moderately/slightly complex visit with a medically fit history or examination and low medical decision-making. The date lasts 20–29 minutes. Complex or chronic conditions use this code.
- 99214: This code indicates a problematic visit with a medically adequate history or examination and moderate medical decision-making. Encounter dates last 30-39 minutes. Complex medical illnesses or patients with several medical issues often use this code.
- 99215: This code represents the most complex assessment and management services. It requires a medically acceptable history or examination and advanced medical decision-making. Encounter dates last 40–54 minutes.
Also: CPT Codes for Pain Management
CPT Codes: 99242 – 99245
- 99242: A physician uses CPT code 99242 for at least 20 minutes of medically relevant history or examination and simple medical decision-making.
- 99243: A physician uses CPT code 99243 for a medically qualified history or examination with limited medical decision-making that takes at least 30 minutes.
- 99244: A physician uses CPT code 99244 for a medically suitable history or examination and moderate medical decision-making for at least 40 minutes.
- 99245: A physician uses CPT code 99245 for a medically relevant history or examination requiring high-level medical decision-making that lasts at least 55 minutes.
HOME OR RESIDENCE VISIT TO EVALUATE AND MANAGE A NEW PATIENT – CPT CODES
- 99341: Requires a medically suitable history or examination, straightforward medical decisions, and 15 minutes with the patient.
- 99342: A medically suitable history or examination, limited medical decision-making, and 30 minutes with the patient are needed.
- 99344: CPT code 99344 requires a medically adequate history or examination, moderate medical decision-making, and 60 minutes with a patient.
- 99345: Requires a medically suitable history or examination, high-level medical decision-making, and 75 minutes with the patient.
HOME OR RESIDENCE VISIT TO EVALUATE AND MANAGE OF AN ESTABLISHED PATIENT – CPT CODES
- 99347: For simple medical assessments, medically suitable histories, and exams. Visits must last 20 minutes.
- 99348: This code is used for visits that involve moderate medical decision-making and a relevant history or examination. Visits must last 30 minutes.
- 99349: For visits needing a lot of medical judgment and a medically suitable examination or history. Visits must last 40 minutes.
- 99350: Medically acceptable history or examination and high-level medical decision-making visits are included in 99350. Visits must last 60 minutes.
MEDICAL TEAM CONFERENCE WITH INTERDISCIPLINARY HEALTH CARE PROFESSIONALS—CPT CODES
- 99366: A non-physician healthcare provider visits with a patient or family member for 30 minutes or more.
- 99367: A physician attends an interdisciplinary team meeting for at least 30 minutes without the patient or family.
- 99368: A physician attends an interdisciplinary team meeting for at least 30 minutes without the patient or family.
MEDICATION THERAPY MANAGEMENT SERVICES – CPT CODES
- 99605: New patient’s initial 15-minute session. This code is used for billing for a pharmacist’s first 15-minute medication therapy management session with a patient.
- 99606: Used for an established patient’s first 15-minute session. This code is used for billing for a pharmacist’s second 15-minute MTM services session with a patient.
- 99607: This code is used for every 15 minutes of the pharmacist’s MTM services in a face-to-face session with the patient. Whether the patient is new or established, this code is used with code 99605 or 99606.
OTHER ESSENTIAL CPT CODES
Advance Care Planning – 99497
Discussing end-of-life care and treatment preferences with medical professionals, patients, and their families is a part of advanced care planning. This procedure is essential for older persons because it ensures that their wishes are followed and that they get the care they need and want. For billing services related to advanced care planning, CPT code 99497 is used.
Chronic Care Management – 99490, 99487, 99489
Care coordination, patient education, and routine check-ins with healthcare professionals are all part of CCM. Depending on the complexity and amount of time spent on care coordination, CPT codes 99490, 99487, and 99489 are used for billing CCM services.
Transitional Care Management – 99495, 99496
This service is available to patients moving from a hospital or skilled nursing facility to their homes or community. TCM comprises a thorough evaluation, drug administration, and care coordination with other medical professionals. TCM services are billed using CPT codes 99495 and 99496.
Conclusion
These codes let providers treat patients and receive reimbursement. As geriatrics evolves, we’ll see more CPT codes specially designed for older individuals’ unique requirements.