Some Tips for Billing with CPT CODE 99204

If you work in the medical profession, and particularly if you work in billing, you will always want to make sure that you understand different Medicare billing coding so that your patients can rely on you to process everything correctly.  Your patients have enough to worry about without having to be concerned with being covered on their visits.  That is why it is the medical provider’s responsibility to understand precisely how everything has to be filed.  Making mistakes with this sort of thing can be devastating to your patients, even if it is only for a short period of time.  This article will attempt to give a brief, simple explanation of CPT CODE 99204 in order to help you to avoid common mistakes that come with the billing of Medicare.  This is hardly all inclusive, but it is a good reference for those who work in the medical field and need to handle billing for Medicare patients.

CPT CODE 99204

This particular code is one that provides coverage for those who are on Medicare for outpatient visits.  These visits are generally for evaluations, and you will need to include a history of the problem, an examination, and decision making that is perfectly straightforward.  For this particular code, the time period is 45 minutes.  You need to make sure that the code matches the level of service that the patient is receiving, and it is always important to keep in mind that the necessity of the specific visit from a medical standpoint is the most important thing to document.  It is possible to use a billing specialist or a different resource to review what services were provided prior to the claim being given to the payer, but you also must keep in mind that it will always be the responsibility of the medical provider to make sure that everything is documented correctly.

You will need to be completely certain that the medical records fully support the amount of service that will be paid for.  Keep in mind that the amount of documentation that is necessary does not necessarily determine what is going to be billed.  Make sure that you document whether the patient is new or established.  If the patient has not been seen by you or your partners in over three years, then you will want to document them as a new patient rather than a returning patient, and you will want to choose the proper code as it applies to the specific patient.  This is essential to documenting everything correctly so that there are no billing errors submitted.

So long as you keep a few of these tips in mind, you ought to be able to always document all of your billing records correctly and always submit the correct paperwork to the payer.  You always want to do whatever you can to take care of your patients, and that includes always filling out the paperwork with the proper codes and properly submitting it to the payer.