Question:
What’s the accurate level of service for a patient who presents with a sore throat, has a positive strep test, and is put on antibiotics?
Answer:
The September 2025 CPT® Assistant posed this question and said the level of service was 99213. Let’s look at this in grid form to see why. You need two of three elements to meet or exceed the requirements for a service. The patient presented with an acute, uncomplicated condition, had one lab test, and was given a prescription. Some practitioners think a prescription automatically means a level four visit. It doesn’t. You can substitute otitis or any other acute, uncomplicated condition for the presenting problem, and it audits as a 99213.
What about a patient who presents with a cough, is tested for COVID, flu, and strep, and given a prescription? Is that a level four visit? That depends on the codes used for the point of service tests. There are combination codes that test for COVID and influenza A&B that are reported with the same CPT® code. If your group is using one of those tests, then count two unique tests ordered. A coder wouldn’t credit four tests for a lipid panel, because crediting unique tests is by CPT® code. Codes 87636 and 87637 are CLIA-waived tests that can be done in the office. That and the quick strep test result in two unique lab tests. The visit audits as a 99213.
Using the same cough example, the physician orders a pulmonary function test, along with the combination COVID and flu test and a quick strep test, and orders a prescription cough syrup. Now, we have a level four visit using data and risk.
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