What CPT (Current Procedural Terminology) code is used for an established patient returning to the office to review laboratory results?

CPT Coding for Laboratory Results Review Visit

For an established patient returning to review laboratory results, use CPT codes 99212-99215 based on either the total time spent or the medical decision-making complexity during that visit. 1, 2

Code Selection Framework

The appropriate code level depends on which method yields the higher justified level of service:

Time-Based Coding

• 99212: 10-19 minutes total time 1, 2
• 99213: 20-29 minutes total time 1, 2
• 99214: 30-39 minutes total time 1, 2
• 99215: 40-54 minutes total time 1, 2

Time-based billing requires documenting the total face-to-face time spent with the patient on the date of the encounter. 1

Medical Decision-Making (MDM) Based Coding

• 99212: Straightforward MDM 1, 2
• 99213: Low complexity MDM 1, 2
• 99214: Moderate complexity MDM 1, 2
• 99215: High complexity MDM 1, 2

To qualify for a specific MDM level, you must meet 2 out of 3 elements: number/complexity of problems addressed, amount/complexity of data reviewed, and risk of complications. 1, 2

Key Documentation Requirements

Problems must be actively addressed during the encounter, not merely listed in the chart. 1, 2 Simply reviewing normal lab results with no changes to management typically qualifies as straightforward or low complexity MDM. However, if the lab results reveal new problems requiring management decisions, this elevates the complexity.

For example, an "undiagnosed new problem with uncertain prognosis" discovered through lab results qualifies as moderate complexity. 1, 2

Billing Strategy

Calculate both the time-based and MDM-based code levels for the encounter, then bill whichever is supported by documentation and yields the appropriate level of service. 1 This is compliant with current American Medical Association guidelines. 1

Common Pitfalls to Avoid

• Do not use outdated 2013 time thresholds—the 2021 guidelines significantly changed time requirements, with lower time thresholds for most codes. 1, 2
• Do not bill preventive care codes (like 99391-99397) when the visit is specifically for reviewing diagnostic test results rather than routine wellness care. 1
• Ensure documentation explicitly shows which 2 of 3 MDM elements were met if billing based on MDM complexity. 2
• Document total time if using time-based coding, as this is required to support the code selection. 1