Wiki 99485 & 99486

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Jennifer CPC

Jennifer CPC

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HELP...I have contacted the AAPC and the AMA regarding this and I still can't get an answer. In the 2016 CPT Professional Edition by the AMA on page 43 left column about half way down it states "Code 99485 is used to report the first 16-45 minutes of direction on a given date and should only be used once even if time spent by the physician is discontinuous. Do not report services of 15 minutes or less or any time when another physician is reporting 99466, 99467." OK.

On page 43 right column about half way down it states "Code 99485 is used to report the first 30 minutes of non-face-to-face supervision of an interfacility transport of a critically ill or critically injured pediatric patient and should be reported only once per date of service." Um....they just said it's for 16-45 mins now they are saying the first 30 mins. ???? A couple lines down it states "Code 99486 is used to report each additional 30 minutes beyond the initial 30 minutes. Non-face-to-face interfacility transport of 15 minutes or less in not reported." But they just said 16-45!

And finally on page 44 in the code description it states " blah, blah, blah.....FIRST 30 MINUTES.

I am soooo confused. Can someone PLEASE help me? I get that the first 15 minutes can not be billed for. BUT..Does it mean that it can't be counted UNLESS they hit 16 minutes or more and then it is retroactive to the first minute through the 30th minute. OR does it mean that the first 15 minutes is not billed at all (which I can't imagine any physician letting that fly) and the clock doesn't start till the 16th minute?
 
To bill a timed service you must have a minimum of one half plus 1 minute of the required time before it can be billed. So for a 30 minute service you must have a minimum of 16 minutes documented before it may be coded. Then the next allotment, in this case 30 minutes, you must be one half plus one minute before it may b coded. Therefor 16 minimum for the first 30 minutes up to 30 but then for the second 30 you would need 16 more minutes so 30 plus 16 for 46 minutes before you could use both codes. So the first interval starts at 16 thru 45 minutes the second starts at 46 thru 75 minutes.
 
99485 & 99485

mitchellde said:
To bill a timed service you must have a minimum of one half plus 1 minute of the required time before it can be billed. So for a 30 minute service you must have a minimum of 16 minutes documented before it may be coded. Then the next allotment, in this case 30 minutes, you must be one half plus one minute before it may b coded. Therefor 16 minimum for the first 30 minutes up to 30 but then for the second 30 you would need 16 more minutes so 30 plus 16 for 46 minutes before you could use both codes. So the first interval starts at 16 thru 45 minutes the second starts at 46 thru 75 minutes.
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WOW - OK that makes TOTAL sense now. Where can I find this in documentation for a policy I am writing? Why couldn't the AMA just write that? lol
 
You might try looking it up in the Medicare manual under timed services. I know then have a section for this. It may not cover those specific codes but a timed service is a timed service.
 
I wish they would add a time to code chart in the CPT book guidelines like they have for adult Critical Care and prolonged services. Those charts are based off an hour though but it might be good format to use to create something similar for the policy you are writing
 
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