Wiki midpoint

[stephmescher]

I was looking for some guidance on the midpoint for 99402- code reads approx. 30 mins. We spent 20 minutes with a patient so would this qualify for the billing of 99402 since we crossed the midpoint of the 30 minutes.
Thanks

 

[prayercoder]

For 99402, Optum360 Encoder Pro.comProfessinal says,' Face-to-face services for new and established patients based on 15- to 60-minute time increments; Report 99401 for encounters lasting 15 minutes; 99402 for 30 minutes; 99403 for 45 minutes; and 99404 for a duration of 60 minutes.". It doesn't mention midpoint.
It seems since you did not reach 30 minutes, you would bill 99401 and your time must be documented.

 

[Cynthia Hughes]

It is correct to use the midpoint rule for codes 99401-99404. CPT Assistant used code 99401 as an example for use of the midpoint stating that 8 minutes were required to report 99401. The midpoint applies whenever there is no other time instruction in the prefatory instructions or code descriptors.
Cindy

 

[mkmgt001]

I agree that the midpoint applies and 99402 could be reported in your case. I have a 2021 CPT Professional Manual and "TIME" guidelines including "mid-point" are explained under the "Introduction" section at the front of the CPT manual (page xvii in my manual) . These are the guidelines that should be followed for time-based codes UNLESS there are specific instructions for that code.