Wiki prolonged service code G2212 billed with same day procedure

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jcrahan13

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Can anyone clarify the rules for billing prolonged time code G2212? Medicare is paying for it on some claims and will not on others. Does a procedure, for example a straight cath 51701 or urodynamic procedure 51725, affect them paying on this code?
 
jcrahan13 said:
Can anyone clarify the rules for billing prolonged time code G2212? Medicare is paying for it on some claims and will not on others. Does a procedure, for example a straight cath 51701 or urodynamic procedure 51725, affect them paying on this code?
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G2212 is only for use for prolonged E&M services - if you haven't billed an E&M code for that date of service, then G2212 can't be used and won't be paid. For an office visit, it can only be used with CPT codes 99205 or 99215 because it represents the additional time above and beyond the highest timed base code. If you're using it as an add-on code to lower level office visit codes, then it's being coded incorrectly.

Billing a procedure on that same date shouldn't affect whether or not G2212 is paid. But Medicare only allows a maximum of 4 units for G2212 - if you're billing more than 4, it will be denied.

Here's one Medicare contractor's guidance on this code that you can reference:
 
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