Understanding Primary Care CPT Codes

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Understanding Primary
Care CPT Codes
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Understanding Primary Care CPT Codes
Understanding Primary Care CPT Codes Navigating
the world of medical billing codes can be
overwhelming, especially for those in the primary
care field. There are several primary care
Current Procedural Terminology (CPT) codes used
to describe the various services and procedures
offered to patients. These codes are crucial for
billing and reimbursement purposes, and
understanding them is vital for the success of
any medical practice. In this article, we will
take a closer look at the different primary care
CPT codes, including office visit codes,
preventive visit codes, preventive medicine
services codes, special primary care CPT codes,
lab testing codes, and vaccinations codes. 1.
Office Visit Codes (99202-99205
99211-99215) The primary care CPT codes
99211-99215 and 99202-99205 are used to bill for
evaluation and management services provided in an
office or other outpatient setting. These codes
are differentiated based on the complexity of the
visit, with lower level codes used for less
complex visits and higher level codes used for
more complex visits. The codes 99211 and 99212
are typically used for minor medical services
that do not require the presence of a physician,
while codes 99213-99215 and 99202-99205 are used
for visits that require medically appropriate
history and/or examination, and varying levels of
medical decision-making. It is important for
providers to accurately document the complexity
of the visit to ensure appropriate reimbursement
and minimize the risk of audits or denials.
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Understanding Primary Care CPT Codes
2. Preventive Visits Codes (99391
99397) Preventive care visits are an important
aspect of primary care, and there are several CPT
codes that are used to bill for these services.
The CPT code range for preventive visits is 99391
99397. These codes are used for preventive
services, such as annual wellness exams, that are
aimed at maintaining and improving the patients
overall health and well-being. The specific code
used depends on the patients age and the
complexity of the visit. These codes may cover a
range of services, including physical exams,
health screenings, immunizations, and counseling
on healthy lifestyle choices. Accurate
documentation of the services provided and the
medical decision-making involved is critical to
ensure appropriate reimbursement for these
important preventive care services. 3.
Preventive Medicine Services Codes (99381
99387) CPT code range 99381-99387 represents
preventive medicine services for patients of
different ages, ranging from infancy to
adulthood. These codes are used by primary care
providers, such as family physicians, to provide
preventive care services to their patients. It is
important to note that these codes should only be
used for preventive medicine services and not for
diagnostic or therapeutic services. These codes
are used to report comprehensive, age-specific
preventive medicine evaluations and management of
an individual patient. The services included in
this range of codes may include a comprehensive
medical history and physical examination,
age-appropriate counseling and risk-factor
reduction interventions, and screening for
various medical conditions. Proper documentation
is necessary to ensure accurate billing and
reimbursement for these services.
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Understanding Primary Care CPT Codes
4. Special Primary Care CPT Codes (93306, 93880,
93923, 76705, 93005, 94640, 87804, 94375, 81025,
87880, 92551, 81000, 99173) The special primary
care CPT codes refer to a set of codes that are
commonly used in primary care settings to
describe a range of diagnostic, screening, and
therapeutic procedures. These codes include 93306
for echocardiography, 93880 for vascular
ultrasound, 93923 for peripheral arterial
studies, 76705 for abdominal ultrasound, 93005
for electrocardiogram, 94640 for nebulizer
treatment, 87804 for infectious agent detection
by nucleic acid, 94375 for breath carbon monoxide
analysis, 81025 for urinalysis, 87880 for
infectious agent detection by immunoassay, 92551
for pure tone audiometry, 81000 for urine
pregnancy test, and 99173 for vision screening.
Understanding the appropriate use and
documentation requirements for each of these
codes is essential for accurate billing and
reimbursement in primary care settings. 5. Lab
Testing Codes (83036, 85025, 80053, 84439, 80061,
80076, 84153, 84443, 87880, 87804, 82306, 83704,
86900, 88142, 84481, 86003) These lab testing
codes cover a wide range of diagnostic tests and
procedures that are commonly ordered by
healthcare providers. Code 83036 covers the
measurement of Hemoglobin A1c, which is commonly
used to monitor blood sugar levels in patients
with diabetes. Code 85025 covers the complete
blood count (CBC), which is a standard blood test
that provides information about a patients
overall health status. Code 80053 covers a
comprehensive metabolic panel, which provides
information about kidney function, liver
function, and electrolyte balance. Other codes
cover tests such as thyroid function tests, lipid
panel tests, and infectious disease screening
tests. Accurate coding and documentation of these
tests is important for proper billing and
reimbursement, as well as for effective patient
care.
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Understanding Primary Care CPT Codes

• 6. Vaccinations Codes (90649, 90736, 90636,
  90733, 90632, 90691, 90732, 90746, 90707, 90713,
  90715, 90656)
• These are common vaccine CPT codes used in
  medical billing. CPT code 90649 is used for the
  human papillomavirus (HPV) vaccine, while CPT
  code 90736 is used for the meningococcal vaccine.
  CPT code 90636 is used for the influenza vaccine,
  while CPT code 90733 is used for the hepatitis B
  vaccine. CPT code 90632 is used for the
  pneumococcal vaccine, and CPT code 90691 is used
  for the rotavirus vaccine. CPT code 90732 is used
  for the pneumococcal vaccine, and CPT code 90746
  is used for the zoster vaccine. CPT code 90707 is
  used for the measles, mumps, and rubella (MMR)
  vaccine, while CPT code 90713 is used for the
  tetanus, diphtheria, and pertussis (Tdap)
  vaccine. CPT code 90715 is used for various
  vaccines, including the MMR and Tdap vaccines.
  Finally, CPT code 90656 is used for the influenza
  virus vaccine, high dose formulation.
• In conclusion, understanding primary care CPT
  codes is essential for accurate and appropriate
  medical billing. Primary care physicians need to
  be familiar with the primary care CPT codes and
  the documentation requirements for each code to
  ensure that they are billing correctly and
  avoiding potential audits or denials. From office
  visit codes to lab testing codes, preventive
  medicine services codes, special primary care CPT
  codes, and vaccinations codes, each code serves a
  specific purpose, and it is vital to use the
  appropriate code for each service provided. By
  following the billing guidelines and tips for
  each code, primary care physicians can ensure
  proper reimbursement for their services, while
  providing the best possible care for their
  patients.

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Understanding Primary Care CPT Codes
Due to the fact that CPT is a registered
trademark of the American Medical Association, we
are unable to provide a complete list of CPT
descriptions and guidelines. We have provided
this information solely for reference purposes
for healthcare providers, and we strongly advise
that providers adhere to the appropriate billing
guidelines to ensure accurate and compliant
billing practices. About Medisys Data Solutions
(MDS) Medisys Data Solutions (MDS) is a leading
healthcare revenue cycle management company that
provides reliable and efficient billing services
for primary care practices. With a team of
experienced medical billing professionals,
Medisys Data Solutions understands the complex
coding and billing requirements of primary care
services, including office visits, preventive
medicine services, special primary care CPT
codes, lab testing, and vaccinations. We are
committed to maximizing revenue for primary care
practices while minimizing administrative burden
and improving cash flow. Primary care practices
can rely on Medisys Data Solutions for their
billing needs and focus on providing quality
patient care. To know more about our primary care
billing services, contact at info_at_medisysdata.com
/ 888-720-8884
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