Provider wanting to bill CPT code 25075 X 3 , 99215, 99417 x2 . provider documented chart review time ( 1 min), documentation time (11 min) , Face Time (9:42am to 10:47am), and Total time ( 95 min) for visit. My question is should 99215 with 99417X2 even be billed when provider did not document Time spent on procedure.
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Wiki 25075 x3 , 99215 , 99417 x2 with out separate documentation of OV time and procedure time?
- Thread starter ntreber
- Start date
YLG74
New
Time spend on each activity should be documented. if 99215 was documented not based on time but on documentation. then the time spend for 99417 should have additional elements and documentation carved out of the 99215.
The issue is the provider did not document separate time for the procedure (CPT: 25075) E&M of 99215 &99417 X2 is coded by provider based on total time of 95 mins. I am questing the E&M of 99215 with prolonged service code 99417 x2 when provider has not documented time spent in procedure. There is documentation to support and E&M with the procedure. I am just questioning the billing of the E&M with out time spent on the procedure being documented.
skrug888
New
The provider needs to document that the time was above and beyond the procedure time. This is an excerpt from the 2023 E&M Guidelines:
Do not count time spent on the following:
Because of top bullet, the provider should document whether that time is exclusive of the procedure or not. If the total time includes the time for the procedure, the provider could've included a statement carving out the procedure time. Then you would code based on what time is remaining.
Do not count time spent on the following:
- the performance of other services that are reported separately
- travel
- teaching that is general and not limited to discussion that is required for the management of a specific patient
Because of top bullet, the provider should document whether that time is exclusive of the procedure or not. If the total time includes the time for the procedure, the provider could've included a statement carving out the procedure time. Then you would code based on what time is remaining.