Wiki Prolonged office visits office setting

[pmay@trianglearthritis.com]

One of my providers wants to bill prolonged time. From what I can tell IF Medicare can use G2212 for each 15 min increment with 9905 and 99215 only. Does that mean if they spent an additional 31 min I could do 2 units?

I am also finding 99417 but not sure if that is the same for office setting. I am looking for a code to use on commercial plans.

Does anyone have any information on this?

Thank you,
Pamela

 

[jkyles]

Hi there, for information on G2212, start with this CMS guide. https://www.cms.gov/outreach-and-ed.../downloads/eval-mgmt-serv-guide-icn006764.pdf.

You will find information on 99417 as well as general information on billing E/M visits based on time in the current CPT manual.

Be aware that G2212 has a higher total time requirement than 99417. For example, to report two units of G2212 for a new patient office visit the total time for relevant services on the date of the encounter (see the list of activities you can count in the CPT manual) must be at least 104 minutes.

To report 99417 to commercial plans that accept it, the total time must be at least 90 minutes. Be sure to check each commercial plan for which code they accept. I've come across a few that want G2212 so you'd need to follow CMS rules.