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Wiki 99443-Prolonged Tele-Visit

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tadapoof

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Olympia, WA
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Good afternoon. I have a provider who had a phone visit scheduled for a patient to refill chronic meds and to help fill out several disability forms. The provider spent 1 hr. and 23 minutes discussing chronic conditions and medication adjustments and 30 minutes were spent helping patient with paperwork. I know that the provider can't bill how she wanted which was 99443 + G2211 + 99417 x 4 (yes she gets code happy :rolleyes:) and she's a thorough documenter.
I think that she will have to eat the additional time spent due to the visit being audio only. I know that providers want to bill and get paid for their time spent with patients, but how do I explain this?
 
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The provider can only bill 99443 even if the time is greater. When the audio-only CPT codes were created, it was likely not anticipated that there would be occurrences of such prolonged audio-only E/M visits. Even If we look at the prolonged service codes we didn't get any benefit from them as they are all add-on codes and 99443 does not have any add-on code for prolonged services. You have to bill 99443 in this case.
 
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bhardwajv said:
The provider can only bill 99443 even if the time is greater. When the audio-only CPT codes were created, it was likely not anticipated that there would be occurrences of such prolonged audio-only E/M visits. Even If we look at the prolonged service codes we didn't get any benefit from them as they are all add-on codes and 99443 does not have any add-on code for prolonged services. You have to bill 99443 in this case.
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Thanks.
 
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Adding that 99417 can only be billed as an add-on to one of the CPT codes listed in the Code First note in the CPT book:

Code first applicable E/M service code (99205, 99215, 99245, 99345, 99350, 99483)

Additionally, per this CMS document, G2211 would be used with office and outpatient E/M services 99202-99205, 99211-99215:


I just wanted to give you some additional official sources in case the provider pushed back on not being able to bill those codes for an audio-only visit.
 
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