What Is CPT Code 99212 for Established Patient Visits?
Explore CPT code 99212, detailing its application for routine established patient visits and proper medical documentation.
Current Procedural Terminology (CPT) codes are a standardized system used by healthcare providers in the United States. They serve as a universal language for describing medical services and procedures, playing a fundamental role in billing and accurate record-keeping. By assigning specific codes to patient encounters, professionals communicate the services rendered. CPT code 99212 is designated for a particular type of patient visit.
Understanding CPT Code 99212
CPT code 99212 identifies an “Office or Other Outpatient Visit for the Evaluation and Management of an Established Patient.” An established patient is an individual who has received professional services from a physician or another qualified healthcare professional within the same specialty and subspecialty, belonging to the same group practice, within the past three years. These services must have involved a face-to-face encounter. If a patient has not had such an encounter within this timeframe, they are considered a new patient.
This code applies to straightforward, low-complexity encounters. It signifies a visit where the patient’s presenting problem is minor or self-limited, not involving new, complex, or serious medical issues. The code reflects the minimal nature of the services provided during the appointment.
Key Components of a 99212 Visit
To qualify for CPT code 99212, a visit must meet specific clinical criteria related to history, examination, and medical decision making (MDM). The encounter typically requires a medically appropriate history and/or examination. A problem-focused history is generally sufficient, concentrating on the patient’s chief complaint and relevant medical background.
A problem-focused examination is usually performed, limited to the specific body area or system related to the patient’s presenting issue. Medical decision making for a 99212 visit is straightforward. This level of MDM indicates a minimal number of diagnoses or management options, a minimal amount and/or complexity of data reviewed, and a minimal risk of complications or morbidity. When time is the basis for code selection, the total time spent on the date of the encounter, including both face-to-face and associated non-face-to-face activities, typically ranges from 10 to 19 minutes.
Typical Scenarios for 99212 Use
CPT code 99212 is used for common, routine medical situations, including:
- A brief follow-up appointment for a stable chronic condition, such as hypertension or diabetes, where the patient’s status remains unchanged.
- A medication refill request for a well-controlled condition, where a quick assessment confirms ongoing stability.
- Reviewing routine laboratory results when no new problems are identified and findings are within expected parameters.
- Patients presenting with minor, self-limited problems, like an improving common cold or a minor skin rash.
- A post-operative visit for a minor procedure with an uncomplicated recovery.