Wiki Prolonged services

Create Wiki
B

beulastella

Networker
Messages
71
Location
Coimbatore, TN
Best answers
0
Hi,

We have the prolonged services reporting guidelines as

1610013580147.png1610013593385.png

Where we have instruction as
For New Patient Visits:
If total time is less than 15 minutes No Code will apply
If time is greater than 74 minutes add Prolonged EM Service
For Established Patient Visits:
If total time is less than 10 minutes No Code will apply
If times greater than 55 minutes add Prolonged EM Service
from https://www.aapc.com/business/em-audit-tool-ebrief.aspx

Again confusion from the other link as https://www.aafp.org/journals/fpm/blogs/inpractice/entry/three_coding_changes.html


1610013756228.jpeg
Which one is exactly the correct. As everyone in the Learning phase.. Can some one please elaborate on the time ranges?

Thanks,
 
After I reviewed the codes 99417 and G2212, I believe they are DIFFERENT in how you may report them. 99417 you may start reporting in the first minute after you go over the MAX minutes of the highest level. CMS decided to go a different route, and this is why G2212 was created and they do not allow you to report until you have reached 15 minutes OVER the MAX minutes of the highest level E/M. This is my interpretation, please let me know (anyone) if this is correct or not.
 
Yes Thank you Dkissel, im taking the point from you that "99417 you may start reporting in the first minute after you go over the MAX minutes of the highest level" 54 is my Level 99215 then from 55 itself i can use 99417 considering the range. Am i correct?
 
Yes, you can begin using 99417 at 55 minutes (40+15) but you may not use G2212 until you reach 69 minutes ( 54+15). This is my understanding.
 
SOOO, I'm late to the party. We haven't seen patients in 2021 yet except one emergency (we're technically still on vacation, but we're doing year-end cleanup work), so I've been a little lax on getting my ducks in a row regarding E&M time. The way I understand it, we are NOT rounding on these prolonged service codes, so the full 15 minutes must be spent before the code can be used. So if you spend 29 extra minutes, you can ONLY code one unit of 99417/G2212.

YES? NO? Is rounding allowed on the non-Medicare (the 99417)?

I'm basing my comment on the table in the Federal Register (they used 99417 instead of G2212):

1610225571125.png
 
Last edited:
Now I'm replying to myself... Here is a table I created. Can someone check me? The doctor does spend 2 hours or more with some of his patients.

1610226915911.png
 
SharonCollachi said:
Now I'm replying to myself... Here is a table I created. Can someone check me? The doctor does spend 2 hours or more with some of his patients.

View attachment 5004
Click to expand...
Sharon, this is what I am reading it to be. Be aware you may get some commercial carriers that decide to go with the G code as it is in their benefit to do so. This is a message I read on BCBS of Michigan: CPT code *99417 is not covered. When billing an add-on code for prolonged office or other outpatient evaluation and management services with the primary CPT procedure code, use HCPCS code G2212 instead of *99417.
 
hrshea46 said:
Is the 99417 & G2212 used for prolonged service when doing a audio/visual Telehealth?
Click to expand...

99417 reported as an add on to the following E/M codes: 99205, 99215, 99245, 99345, 99350, 99483

G2212 can reported as an add on to the following E/M codes: 99205, 99215, 99483

Per EncoderPro, 99417 can be reported with Modifier 95. If the documentation supported the requirements for the E/M Level and the total time, then I would say it could be billed.

(That could be subject to change after the end of the PHE - I haven't familiarized myself with those changes yet, because my physicians don't bill telehealth due to the nature of their specialty.)
 
You must log in or register to reply here.
Top