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E/M coding

  1. Default E/M coding
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    I have a question, i hope someone can help me or point me in the right direction. I work in an OBGYN Clinic and i have a doctor who spent 60+ min with an established patient for depression. I want to know if i can charge more than a 99215, which is only 40 minutes. It seems like money lost. Is there another E/M add on code or code i can use with it? Any help greatly appreciated. She wants to charge for the 60 + minutes.

  2. #2

    First, as I'm sure you already know, we should only bill what is medically necessary (did the provider really need to spend the extra 20+ minutes with the patient?) in order to get correctly paid.
    With that said, my first thought goes to Prolonged Care Services. CMS explains this likewise:
    "You can only bill the prolonged services codes if the total duration of all physician or qualified NPP direct face-to-face service (including the visit) equals or exceeds the threshold time for the evaluation and management service the physician or qualified NPP provided (typical/average time associated with the CPT E/M code plus 30 minutes)."

    This translates into 99215 of a total of 70 minutes (40 minutes from 99215 + 30 minutes to bill 99354). This time must be well-documented as CMS further explains: "You must appropriately and sufficiently document in the medical record that you
    personally furnished the direct face-to-face time with the patient specified in the CPT code definitions. Make sure that you document the start and end times of the visit, along with the date of service.

    If that is not appropriate, be very careful not to unbundle the E/M code (depression screens, etc.), as this often leads coders/providers into trouble.

    Hope this is helpful!
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

  3. Default
    Thank you! That is very helpful. Personally i think it should just be the 99215, she didnt need to spend 1 hour with the patient.

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