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CPT code 4012F currently has no summary available; Data not available in the input.
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A typical patient is a middle-aged adult referred for health maintenance or disease management review where quality reporting requires documentation of a specific prevention or care metric tied to 4012F. The visit often occurs in a primary care clinic or outpatient preventive cardiology setting. The clinical workflow begins with the patient check-in and vitals, followed by a focused history and assessment of cardiovascular risk factors, medication adherence, and counseling on lifestyle. The clinician documents the metric outcome in the electronic health record, attaches any necessary lab or diagnostic results, and completes the standardized quality measure form for submission. Coding and billing staff review the chart to ensure 4012F is recorded correctly on the claim and apply appropriate visit CPT/HCPCS codes and possible modifiers before submission to payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes. | Common E/M code used when documenting the visit during which 4012F is assessed and recorded. |
|99406|Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes.|Often performed alongside metric documentation when counseling is required for risk modification related to 4012F outcomes.
|36415|Collection of venous blood by venipuncture.|Used when laboratory tests supporting the quality metric tied to 4012F require blood draw.
|93000|Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report.|Performed when cardiovascular risk assessment associated with 4012F includes ECG evaluation.
|96160|Administration of patient-focused health risk assessment instrument (e.g., health risk appraisal).|Used when structured risk assessments relevant to the metric are completed during the visit documenting 4012F.
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| Modifier | Description | When to Use |
|---|---|---|
| 25 | CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable… | - When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,… |
| 26 | Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical… | - Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a… |
| 59 | Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)… | - Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a… |
| 57 | CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a… | - Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision… |
| 91 | Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,… | - Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor… |
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| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Family Medicine Physician | Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt… |
| 207R00000X | Internal Medicine Physician | A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults… |
| 208D00000X | General Practice Physician | A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. |
| 363L00000X | Nurse Practitioner | (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak… |
| 363A00000X | Physician Assistant | A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and… |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist |
| 171400000X | Health & Wellness Coach | The Health & Wellness Coach is trained in motivational theories, strategies, and communication techniques, which are used to assist patients to develo… |
| 207RH0000X | Hematology (Internal Medicine) Physician | An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl… |
28 rows
| ICD-10-CM Code | Description |
|---|---|
| E11.9 | Type 2 diabetes mellitus without complications |
| E66.9 | Obesity, unspecified |
| E78.2 | Mixed hyperlipidemia |
| E78.5 | Hyperlipidemia, unspecified |
| F17.210 | Nicotine dependence, cigarettes, uncomplicated |
| G45.0 | Vertebro-basilar artery syndrome |
| G45.9 | Transient cerebral ischemic attack, unspecified |
| I10 | Essential (primary) hypertension |
| I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site |
| I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris |
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