Wiki 99496 and G2212

[sheilakazmerski]

Can you bill G2212 with a 99496? I don't see any CCI edits stating now but we have a denial stating g2212 wasn't reported with appropriate primary code.

 

[jkyles]

Can you bill G2212 with a 99496? I don't see any CCI edits stating now but we have a denial stating g2212 wasn't reported with appropriate primary code.

Hi there,

You can't report it with TCM. The full descriptor for G2212 tells you the three codes it can be reported with:

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report G2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report G2212 for any time unit less than 15 minutes)

G2212 is an add-on code, so looking at the NCCI procedure-to-procedure edits won't tell you which primary codes it can be reported with. Check the NCCI add-on code file for that information: https://www.cms.gov/medicare-medica...ci/ncci-medicare/medicare-ncci-add-code-edits

Medicare's rules for reporting prolonged service codes are located here: https://www.cms.gov/files/document/r11842cp.pdf