99213 or 99214? Three Tips for Navigating the Coding Conundrum

Richelle Marting, JD

Disclosures

Fam Pract Manag. 2018;25(4):5-10. 

In This Article

Abstract and Introduction

Introduction

Perhaps one of the most confounding aspects of evaluation and management (E/M) coding is the distinction between a 99213 and a 99214 visit. Some may view this as a distinction without a difference, but medical practices that confuse the two codes either forfeit revenue earned or risk penalties for upcoding.

Family physicians provide a staggering number of established patient office visits each year — 38,249,187 in 2016, according to the Centers for Medicare & Medicaid Services (CMS).[1] Of those, 42 percent were reported as 99213 visits and 50 percent were reported as 99214 visits. With these two codes accounting for such a large proportion of office visits, and with a difference of about $35 per visit (using the national average Medicare allowed amounts), the distinction between the two can quickly become significant. For example, 250 Medicare visits coded 99213 rather than 99214 amounts to nearly $9,000 less revenue.

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