Medical Billing

cpt office visit codes

All You Need To Know About CPT Office Visit Codes

As you already know there are hundreds of codes for each medical treatment, and many of them are categorized together because they are related. This grouping makes it easier for a coder to understand which healthcare service might they find under which category. Talking about categories, one of the groups is CPT office visit codes.

These codes are different from others. One best part about office codes is that they simplify the complex and lengthy process of medical billing. But how? Let’s dive into the world of CPT office visit codes and explore their significance in the medical industry.

What Does Office Visit Mean?

patient in the clinic with doctor

In the health sector, normally a patient comes to get treated. They are admitted to the hospital and their procedure is started. So the medicines they are given in that period, plus the treatment they received will all be mentioned in the bill. This is a straightforward procedure. 

But sometimes, in a clinic setting, when the patient arrives, the doctor or physician checks the severity of health. If mild treatment can be done, the doctor will provide its service in the office, and the patient will get a cure without even being admitted to the hospital. So, here are the CPT office visit codes. 

Instead of mentioning each service and equipment separately in the bill, these codes make it easier to include treatments that are done within the office without making the bill complicated. So that’s why CPT office visit codes are used extensively in healthcare. 

In What Situations CPT Office Visit Codes Are Used?

Even after understanding the basic role of office codes, you should know when exactly these codes are used. Learning about their usage will help you better differentiate it from other codes, which in turn will make your code interpretation work easier. With the help of specific terms, let us tell you where it is used.

Routine Checkups

When a patient visits the doctor for a routine checkup, CPT office visit codes are used. The visit could be the first time or regular, in both cases these codes will come into play. The checkup may include reviewing the patient’s health history, body examination, and discussion about health conditions.

Sick Visits

In this case, patients come due to an illness. Many people confuse it with a routine checkup but here “illness” is the difference. Here a patient is not feeling well and they surely will get treatment. As mentioned, in this visit, the patient might receive a careful examination, illness diagnosis, certain tests, and a treatment solution.

Chronic Disease Handling

Chronic diseases refer to conditions like diabetes, asthma, or hypertension. When a patient with these conditions visits doctors, CPT office visit codes are used. But here this is not a one time visit. As these conditions are slowly progressive, the patient has to come multiple times or even for a routine checkup. With the help of CPT codes, these visits are documented including signs to identify a disease or the patient’s progress. 


There are a number of vaccines, each is used to treat different conditions. Office visit codes also cater to patients who come to the doctor for vaccinations or immunizations. Here each vaccine has a different CPT code.


As the name indicates, here doctors provide proper counseling to the patient about their health. Counseling may include lifestyle changes, healthy diet, fitness schedule, smoking, or stress management tips. The goal of counseling is to provide patients with education about their health.

Minor Treatments

Some minor medical procedures that can be performed within an office setting are also defined with CPT office visit codes. These treatments involve wound stitching, mole removal, or joint infections. 

Diagnostic Tests

When a patient undergoes diagnostic tests like x-rays, blood tests, or EKGs during office visits, CPT office visit codes are used in their bill. 

Mental Health Counseling

Other than physical treatments, if someone receives mental therapy or sessions in the office, these codes can be used. But here these codes will be referred to under psychotherapy or psychiatric conditions. 

Preoperative Evaluation

The term might seem a little tricky, but after focusing a bit you will find out what it is about. Before going to surgery, patients often take a preoperative evaluation. This procedure helps them assess their fitness, identifying whether they are fit enough for the surgery or not. This examination may include medical history checkups, physical examinations, and further tests.

Follow-Up Visits

CPT office visit codes can also be used for patients who visit doctors after surgery. This visit is crucial for health as it can identify their progress or any ill condition that should be treated as soon as possible. Patients can also do these visits based on their concerns; prevention is better than cure.

Medicine Management

When a doctor or a physician keeps a record of a patient’s medicine information including prescribed medicines, dosage changes, or side-effect monitoring, office visit codes will be used to mention this visit in the bill.

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5 Categories Of Office Visit Codes

So in the previous section, we provided a thorough overview of where CPT office visit codes are used. But if we talk about professional utilization, these codes are seen and used under categories. Each of the visits that we mentioned falls into a category based on which it becomes easier to identify their group and do accurate medical billing. Here are 5 categories of office visit codes, let’s have a look at each:

  1. Evaluation and Management (E/M) Codes

E/M codes are some of the CPT codes that are utilized in healthcare the most. They deal with the assistance given to patients throughout their visits to doctors’ offices, appointments, and hospital stays. The difficulty of these codes is further divided into other categories based on the patient’s history, the breadth of the physical examination, and the intricacy of the medical decisions made.

These codes are crucial for accurately describing the kind and extent of healthcare services and are therefore necessary for billing and payment.

  1. Procedure Codes

Medical involvements carried out by healthcare professionals are covered under CPT procedure codes. These codes specify certain therapeutic, surgical, and diagnostic procedures. To ensure accurate invoicing and recording of medical interventions, procedure codes are used to record the services provided.

Procedure codes can be used for big procedures like open heart surgery or joint replacement as well as simple procedures like skin biopsies and wound treatments.

  1. Diagnostic Testing Codes

Investigations and diagnostic testing are also covered under CPT office visit codes. These codes are used to represent diagnostic procedures including X-rays, MRIs, blood tests, and other investigations. Diagnostic tests must be coded accurately to guarantee that medical professionals are paid fairly for their services.

Identification of the test’s kind and the particular bodily area or system being examined is made easier with the use of these codes.

  1. Surgical Codes

The purpose of surgical codes is to record surgical procedures carried out in various medical disciplines. These codes outline the surgical methods, strategies, and involved anatomical regions of an operation.

Surgical CPT codes are used by surgeons to communicate specific information about the surgical services they offer, assisting in accurate billing and reporting.

  1. Category II & III Codes

There are Category II and Category III codes in addition to the main CPT code categories. Category II codes are optional and are used to monitor patient follow-up following surgery and other performance metrics and quality of care indicators.

Emerging technologies, services, and processes that are undergoing study and review are designated with category III codes, which are temporary.

Utilization Of Visit Codes


Now that you have seen what medical treatments and conditions office visit codes are used for, you still should know how they help in improving medical billing. Besides the basic role of these codes as billing assistants, they also aid in other processes, let’s explore:

Medical Service Description 

These codes are used as a simple language to define patient visits in the bill. Be it a follow-up visit or illness treatment, visit codes help summarize the entire session without complicating the bill.

Billing & reimbursement

As described, the basic role of CPT office visit codes and other codes also have the same purpose and that is to help healthcare facilities get their reimbursement based on accurate coding. When codes are mentioned in the bill, they define specific medical treatments and equipment used during the process. 

Since there are hundreds of patients to deal with, hospitals get relief by using these codes. Otherwise, this process could become lengthy and they would make a number of mistakes that can cost them a loss of revenue.


Not only billing, but CPT codes are a necessary element of claim applications. Healthcare facilities prepare patient claims based on these codes and then the application is sent to the insurance companies. By checking the code accuracy, they approve or reject the claim, and speed up the reimbursement process. This way, insurance companies can pay their patients according to their insurance coverage.

Record Keeping

Besides billing and reimbursement, CPT office visit codes help in keeping the records of patients. This record-keeping lists the information of the patient’s visit, health history, medication details, and other health-related info. 

Treatment Planning

Based on the previous record, doctors can assess the health condition of a specific patient. This helps them judge the necessity of medical treatment so that the patient can receive a proper cure.

Health Improvement

Similarly, doctors can analyze the records to identify whether a person is getting cured or whether they need further treatment. This assessment helps them increase, decrease, or alter the medications.


In healthcare facilities, regulatory bodies take care of medical bills and claims. They regularly audit these bills to make sure no fraud is happening. It also helps them analyze billing records and preserve the details to keep them compliant.


CPT office visit codes can also be used for telehealth treatments. Whenever any patient takes consultation through a call or seeks a virtual visit, it comes under telehealth. So visit codes will act the same as a physical visit.

Research And analysis

These codes are also used for research purposes. It helps researchers find out disease patterns, and most used and less used codes to make alterations and come up with new codes if that is in demand.

Common Mistakes When Using CPT Office Visit Codes

person using laptop, using cpt office visit codes

We have talked much about the positive points of visit codes, but many coders and billers make mistakes while mentioning these codes in the bill. Have a look at these blunders to avoid them in your work.

  1. Incorrect Code Selection

Selecting the incorrect CPT code to describe the services offered during an office visit is one of the most common mistakes. This could take place as a result of unclear code definitions or vague documentation.

  1. Upcoding Or Downcoding

Assigning a CPT code for a more sophisticated or valuable service than what was rendered is known as “upcoding.” The converse is called downcoding, where a simpler code is employed. Both can result in inaccurate billing and even legal problems.

  1. Insufficient Documentation

The problem of incomplete or ambiguous documentation is prevalent. It may be difficult to assign the proper CPT code appropriately if there isn’t enough data in the medical record, which might lead to underbilling or overbilling.

  1. Ignoring Time-Based Codes

Some codes for doctor’s appointments are time-based, which means they are based on how much time is spent with the patient. This aspect may go unnoticed by providers, which might result in improper code assignment.

  1. Neglecting To Use Modifiers

Modifiers are necessary to provide more details about a product or process. Modifiers should be used when appropriate to avoid misunderstandings and claim denials.

  1. Inconsistent Coding Practices

It’s critical for coding procedures to be consistent throughout a healthcare facility. The medical record and claims may be inconsistent as a consequence of different coders or providers utilizing different coding patterns.

  1. Lack Of Education & Training

Errors may occur due to inadequate CPT coding training and instruction. For the latest information on coding updates and best practices, healthcare workers and coders require regular training.

  1. Not Reviewing Code Updates

Every year, CPT codes are revised, and failing to check for and apply these modifications might lead to obsolete coding procedures.

  1. Failing To Document Medical Necessity

An important consideration in coding is medical necessity. Insurance companies may refuse to pay for a treatment or operation if it is not sufficiently documented as being medically essential.

  1. Overlooking Compliance Rules

Neglecting CPT compliance guidelines and laws can have negative legal and financial repercussions. To combat fraud and misuse, healthcare organizations must follow coding requirements.

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    All this information that we gave about CPT office visit codes can only be digested by you when you see it with an example. Here we have listed some common visit codes used, to make you better know what these codes look like.

    CPT Code 99201 (New Patient, Level 1)

    Used for a new patient’s first office visit, which is often a quick contact with no medical decision-making.

    CPT Code 99202 (New Patient, Level 2)

    Appropriate for an office visit with a new patient that calls for a more thorough examination, a more thorough history, and low to moderate levels of medical decision-making.

    CPT Code 99203 (New Patient, Level 3)

    Used for a new patient’s moderately difficult office visit, which comprises a thorough examination, a thorough history, and moderately complex medical decision-making.

    CPT Code 99204 (New Patient, Level 4)

    Appropriate for a thorough office visit with a new patient that includes a thorough history, a thorough examination, and a high degree of medical decision-making.

    CPT Code 99205 (New Patient, Level 5)

    Used for a new patient’s most in-depth office visit, which often entails a thorough history, thorough examination, and a high degree of medical decision-making.

    CPT Code 99211 (Established Patient, Level 1)

    Used for the lowest level of office visits for established patients, frequently for simple follow-up visits or basic services.

    CPT Code 99212 (Established Patient, Level 2)

    Appropriate for a routine office visit with a patient who just needs a brief history, a quick examination, and basic medical decisions.

    CPT Code 99213 (Established Patient, Level 3)

    Used for an intermediate-level office visit with an established patient that includes a thorough medical history, a larger examination, and moderate medical decision-making.

    CPT Code 99214 (Established Patient, Level 4)

    Appropriate for a thorough office visit with an established patient, which often includes a thorough history, a thorough examination, and high-level medical decision-making.

    CPT Code 99215 (Established Patient, Level 5)

    Used for an established patient’s highest-level office visit, frequently requiring a full history, a comprehensive examination, and extremely high-level medical decision-making.

    World Of CPT

    This was the great importance of CPT office visit codes in the healthcare industry. So if you are a medical coder or biller, make sure to use accurate codes. And if the patient’s treatment includes only office visits, remember to use these codes. Never make coding mistakes in the bill, otherwise, you will pay the price.

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