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E/M Prolonged Services for 2021

lhoot

Networker
Messages
38
Best answers
0
Good Morning,

I have a question about the upcoming E/M changes using time. The description of the yet-to-be-numbered code for prolonged services states this code should be added to codes 99205 or 99215 for time units of 15 minutes over the base code's max time and specifically states the prolonged services code should not be reported for any time unit less than 15 minutes. The charts used to illustrate the use of this code are conflicting, as they are using the prolonged services code for a portion of 15 minutes. Is there any further guidance out there on this? My information source is the AMA, see link below.
Thank you for your time today,
Laura Hoot RHIT, CCS

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

99XXX Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)
(Use 99XXX in conjunction with 99205, 99215)
(Do not report 99XXX in conjunction with 99354, 99355, 99358, 99359, 99415, 99416)
(Do not report 99XXX for any time unit less than 15 minutes)

Total Duration of New Patient Office
or Other Outpatient Services (use
with 99205) Code(s)
less than 75 minutes Not reported separately
75-89 minutes 99205 X 1 and 99XXX X 1
90-104 minutes 99205 X 1 and 99XXX X 2
105 or more 99205 X 1 and 99XXX X 3 or
more for each additional 15
minutes.

Total Duration of Established Patient
Office or Other Outpatient Services
(use with 99215) Code(s)
less than 55 minutes Not reported separately
55-69 minutes 99215 X 1 and 99XXX X 1
70-84 minutes 99215 X 1 and 99XXX X 2
85 or more 99215 X 1 and 99XXX X 3 or
more for each additional 15
minutes.
 

Chelle-Lynn

True Blue
Messages
729
Location
Modesto, CA
Best answers
0
I agree that the graphs are misleading. We are going by the description of the code and guidelines that indicate that timeframe less than 15 minutes beyond the 99205-99215 are not to be coded. I am hoping that when they come out with the actual code, they correct this discrepency.
 

lhoot

Networker
Messages
38
Best answers
0
Chelle-Lynn,
Thank you for confirming that this is a bit confusing. Keeping my fingers crossed it will all get worked out.
Laura
 
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