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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
    Default
    Hello,

    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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