When in charge of any type of a healthcare organization, you will absolutely have a lot of responsibilities on your hands. From keeping your patients healthy and happy with the services you are providing, to ensuring proper coding and billing, and thus getting adequate reimbursement from your insurance. This, of course, can often be tricky for some people, especially if they are not knowledgeable enough not only on the practice of coding and billing, as talked about here, but also on its importance.
In other words, some people simply wind up thinking that caring about those codes isn’t so important, and that they can just wing it, expecting to get the best results along the way. Nevertheless, this isn’t the right way to go about it. Why, though? Well, because, if you just wing it and don’t understand the significance of coding, you can easily wind up not getting your reimbursement, given that your claim will be denied.
Since that is not what you want, there is absolutely no doubt that you want to get some important insights for effective documentation and billing. And, since you are here, it is safe to say that you are mostly interested in the medical code 99203, which is what we are going to focus on today, hoping to help you get a clearer understanding about what it is, what it is used for, and how and when you can use it yourself. That’s how you’ll know how to do effective documentation and billing in order to justify using this code and get the reimbursement you deserve.
Understanding CPT 99203
Naturally, we are going to begin with the very basics here. What exactly is the CPT 99203 code? To cut right to the chase, this is a code used to report those outpatient or office visits for new patients – visits that require moderate complexity decision-making from the physician. Clearly, thus, to bill for this code, there are certain requirements that will have to be met during the encountered.
For starters, you need to take a detailed patient’s history, from the current and chief complaint, all the way to the history of previous illnesses, and even past, family and social history. Furthermore, to use the medical code 99203, the actual examination will need to be quite detailed, either involving multiple body systems or focusing on one of those, connected to the presenting problem. Finally, you will need to think about medical decision-making (MDM), because, as we’ve already mentioned, to bill under this code, the MDM will have to be of moderate complexity.
This code is used by various healthcare organizations, chiropractors, massage therapists, physical therapists, and other professionals who are there to improve the health of their patients. It serves to ensure that you, as the provider, are properly reimbursed for the services. So, when you get a better understanding about it, you will be able to meet the necessary requirements, avoid errors, and thus ensure compliance, as well as maximize your reimbursement.
What Are the Documentation Requirements?
Speaking of requirements, let us now proceed to the actual documentation requirements, since thorough and accurate documentation is absolutely extremely important in order to support the billing of the CPT 99203. As already hinted at above, the first requirement regarding the documentation is the actual patient history, so make sure to get as much information as you can, not only about the chief complaint, but also about anything else in the patient history that is worth knowing.
After this, you will have to do, and thus properly document, a physical examination. To be able to bill under this specific code, you should provide documents proving a detailed examination of at least six organ systems, or perhaps two to five systems, but with detailed findings. And then, naturally, you will need to provide the necessary documentation regarding the medical decision-making, so as to offer information regarding the number of problems addressed, the amount and complexity of data reviewed, as well as the risk of complications or morbidity. This should all help you justify the use of the code, and thus get adequate reimbursement.
Read about what medical coders do: https://explorehealthcareers.org/career/allied-health-professions/medical-coder/
Documentation and Billing Practices – What Else to Consider
There are a few more things to consider here in order to go through the documentation and billing process successfully and thus ensure reimbursement. First of all, the patient will be considered new only if he or she hasn’t received any medical services from you as the provider within the last three years. Then, if perhaps time is a determining factor, then the total duration visit should be around 30 minutes.
Of course, you will need to prove medical necessity for the procedures done, and then there is also the fact that you’ll have to use proper modifiers in certain cases. Also, remember that various insurance providers may have different requirements and billing policies. In the end, to ensure effective practices, work with billing and coding professionals, as they will know exactly how to do everything the right way.
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