Prolonged Service codes are time-based built on the total duration of face-to-face time spent by the physician caring for the patient on a given date; such face-to-face time may occur at discrete intervals throughout the day. endobj The results of point-of-care tests are immediate. HW_o67G)h( What Is CPT Code 99417? 226 0 obj endstream Clinicians may use either total practitioner time on the date of service or medical decision making to select a code. PDF Modifier Reference Policy, Professional - UHCprovider.com CPT code 99211 (established patient, level 1) will remain as a reportable service. Code 99417 takes into account both direct and non-direct time (hybrid code) as long as the time occurs on the same date as reporting code 99205 or 99215. This code, which should only be billed with 99205 or 99215, describes an additional 15 minutes beyond the minimum time of the office visit code. They are all part of HCPS, the Healthcare Common Procedure Coding System. They state, An initial service may be reported when the patient has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice during the stay., A stay that includes a transition from observation to inpatient is a single stay. It is an add-on code listed along with the outpatient E/M service. However, only distinct time should be counted. These services require a face-to-face encounter with the patient and/or family that may be performed on a date prior to when the patient actually leaves the nursing facility. Be specific about the services you performed for this patient. {/ 5gf5q%qDofGz}^4G)l:QYtzudc2g`v0,SAB#V EUfu(u0Y~kYx~ePN$1ap$ 0000003984 00000 n The new code, CPT Code 99417, replaces CPT Codes 99354 and 99355. endobj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Code 99417 describes prolonged outpatient E/M service time with or without direct patient contact beyond the required time of the primary service. Coding for prolonged services: CPT and HCPCS codes - CodingIntel Number and complexity of problems addressed at the encounter. When there is overlapping time (e.g., jointly meeting with or discussing the patient) only count the time of one individual. if 99215 was documented not based on time but on documentation. 0000004376 00000 n The issue is the provider did not document separate time for the procedure (CPT: 25075) E&M of 99215 &99417 X2 is coded by provider based on total time of 95 mins. Use 99215 for patients whose appointments are 40 minutes and whose treatment is considered as being of high complexity. 234 0 obj endobj The second type of prolonged service is performed with or without direct patient contact on the date of an E/M service (codes 99417 and 99418). If a test/study is independently interpreted in order to manage the patient as part of the E/M service, but is not separately reported, it is part of MDM. PDF Preventive Medicine and Screening Policy, Professional - UHCprovider.com By clicking Accept, you consent to the use of ALL the cookies. It should not be used for less than 15 minutes of additional time. Review of all materials from any unique source counts as one element toward MDM. (Emphasis added). We and our partners share information on your use of this website to help improve your experience. PDF Physician Fee Schedule (PFS) Payment for Office/Outpatient Evaluation 264 0 obj endobj G2212/99417 pedihc Feb 19, 2021 P pedihc Networker Messages 30 Location Lewiston, ME Best answers 0 Feb 19, 2021 #1 Does anyone have any concrete information regarding these additional codes we can use for prolonged E/M Services. Preparing to see the patient (e.g., review of tests); Obtaining and/or reviewing separately obtained history; Ordering medications, tests or procedures; Documenting clinical information in the electronic health record (EHR) or other records; and. No, not if these tests were separately billed. New prolonged service CPT code for 2021. Telehealth billing for E/M code with add on code; modifier used for 99417? Ensure that the total time spent on the patients care is accurately documented and supports the claim for CPT 99417. Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! 0000005516 00000 n CPT Code 99215 - High Complexity E/m Billing Guide [+2023 Reimbursement The modifier indicates that a significant, separately identifiable service was performed by the same physician or qualified health professional (QHP). Do not report 99417 for any time unit less than 15 minutes. PDF Prolonged Services Policy, Professional - UHCprovider.com HCPCS code G2212 (Prolonged office or other outpatient evaluation and management service (s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact <> This additional time must be documented and billed in 15-minute increments, and CPT 99417 should be reported in addition to the primary E/M service code. 4nXq1\Yv vG%EIY("P^ fD0*3"*E2^0Ij:YL'rFyrI*2r-8?On:9O'g00_M'$Oo )*6_nv["$fLD~)]qS"76n:y{PTd=3y:acvlGR!mk;nVH[bju4 f/Z,hycmk&0Sp|h={XSmaJ4`\gIg^,a mt&HI/: 36e|jBE6.qD4^" .}=oBYN])t`L@Ym3S?H%=$fLb2Df:3AuC7xTT]c7)}XYez~ P^#py>Y.uATO&Dzjf_t/.6i6/k K4 u6?`cQe? <>/Metadata 406 0 R/ViewerPreferences 407 0 R>> 224 0 obj An example of moderate risk might include prescription drug management or a diagnosis or treatment significantly limited by social determinants of health. For a list of approved modifiers, refer to the Modifiers: Approved List section in this manual. CPT 99359: Prolonged E/M service before and/or after direct patient care, each additional 30 minutes. 2021 E/M coding and documentation rules - ACAAI Member (2022) Marrow Biopsy CPT Codes Descriptions, Guidelines, Reimbursement, Modifiers & Examples, CPT Codes For Repair Procedures On The Vestibule Of Mouth, CPT Codes For Behavior Change Interventions, Individual Services, CPT Codes For Destruction By Neurolytic Agent Procedures On The Somatic Nerves. 0000050774 00000 n endobj using the appropriate CPT code and, if required, with modifier 26 appended. The AAFP also advocates for simplified appeals processes and for appeals to be processed in a timely manner. Evaluation and management (E/M) services are at the core of most family medicine practices and represent a category of Current Procedural Terminology (CPT) codes used for billing purposes. 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