Wiki 2021 Time clarification

[KoBee]

I have a few providers who do Pituitary stimulation testing.


In the E/M it only states patient came in for follow up and patient feels well (preschedule testing) providers want to bill a 99215 based on time due to the testing taking about 2-3 hours. From our notes these providers are only assessing the patient to make sure they are doing good while LVN does all other monitoring. Providers want the 99215 because it’s their time.


Now I got a little thrown off, I understand they want the time but if it’s a preschedule test, guidelines are that you don’t get credit for E/M, correct? if its prescheduled?


Or am I wrong, should give the provider the credit based on time due to the length of procedure?


This is what most of my providers want to use: The above mentioned patient was under my care for prolonged visit during GH stimulation testing from 8:30 AM to 11: 20 AM.

hope anyone can help me

 

[nneecole44]

Are you billing a separate CPT code for the Pituitary stimulation testing?

 

[SharonCollachi]

They should be billing for the pituitary testing, not the time-based E&M code. They don't get to choose the E&M if there is a more specific code. (I am assuming there IS a more specific code).

Also, just an FYI, "under my care" doesn't count for a time-based code. It has to be face-to-face, or non-face-to-face work. If the patient is hanging out in your office to see if they have a reaction, or to wait on testing results, that time doesn't count.