Question Coding for extended time consulting with other providers

q1stmdb

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Local Chapter Officer
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Upland, CA
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My provider routinely treats hard to treat patients. This provider will take extensive time to consult with the patient's pharmacist, psychotherapist, psychiatrist, and/or primary care physician. Can this provider charge for this extra time (a single session with another HCP can take more than hour). Discussion will usually involve changing medications, cooperating on behavior modification, extensive history in some cases. However, this time sometime does not happen the same day as the E/M. Is there a different code, or just tack on time to the E/M visit?
 

csperoni

True Blue
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Selden
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There are prolonged care codes, whether on the date of an E/M service (usually 99417or G2212), or a different date (99354, 99355).
Each carrier may have slightly different guidelines, particularly for 99417 vs G2212. AMA came out with guidance for 99417, and Medicare disagreed so they developed G2212.
Here are some references regarding those codes:
I just have to note, I know these providers exist, but I have yet to work with a provider who had an entire hour to speak with another provider about a patient's care. An hour is a really long time. Even tumor board discussions with multiple providers of multiple specialties are not an hour on one patient.
 
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If you use the office/other outpatient specific add-on code for a conversation on the same day the E/M code must be coded based on time.

If the conversation(s) with the other provider(s) take place on a different day then stand-alone code 99358 and add-on code 99359 may be appropriate.
 
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