Wiki Add-On Codes

[JessicaStanley]

When reporting add-on codes such as 96132 or 99497, which include time-based descriptors like "first 30 minutes" or "first hour," is it necessary for the provider to document the service based on time? Or can the service be reported based on medical decision-making (MDM), despite the time reference in the code description? Is it required for the provider to specifically document the amount of time spent when reporting add-on codes?

 

[jkyles]

Hi there, to answer your main question, when a code is only time-based according to the descriptor, the provider must document their time. You can't report based on MDM if it is not an option for the code.

Compare the descriptors for your examples to a level-based E/M code such as 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.

Finally, just as an FYI, both of your examples are primary codes, not add-on codes.

 

[sls314]

When reporting add-on codes such as 96132 or 99497, which include time-based descriptors like "first 30 minutes" or "first hour," is it necessary for the provider to document the service based on time? Or can the service be reported based on medical decision-making (MDM), despite the time reference in the code description? Is it required for the provider to specifically document the amount of time spent when reporting add-on codes?

When you mention add-on codes such as 96132 and 99497, are you referring to the base codes along with their respective add-on pairs—for example, 96132/96133 and 99497/99498?

All of these codes are strictly time-based. Medical decision making (MDM) does not factor into the code selection for these services.

If these are the codes being used, the provider needs to document the time.

You cannot bill for add-on codes that say "each additional 30 minutes" or "each additional hour" without the time documented.

Otherwise, there is no justification for reporting the additional time-based units. If it wasn't documented, it didn't happen.