2. https://www.findacode.com/articles/how-to-properly-report-prolonged-services-using-99417-or-g2212-36784.html, NPI Look-Up Tool (National Provider Identifier), Subtract the upper end of the time range for an established patient E/M (, If this is a Medicare patient, the 15-minute threshold has not been met, therefore it does not qualify for, If this was a private payer who does not follow Medicare guidelines, then the 14 minutes of prolonged time would qualify for one unit of. G0317 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using 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 (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). CPT uses lowest value in time range, CMS uses highest value in time range. (Do not report 99418 on the same date of service as 90833, 90836, 90838, 99358, 99359) CMS is warning that use of G2211 is not expected on claims containing modifiers 24, 25 and 53. How To Properly Report Prolonged Services Using 99417 or G2212. The AMA does not directly or indirectly practice medicine or dispense medical services. This bundle includes the E/M quick reference card, a great tool for quickly identifying the different criteria and time ranges associated with the new E&M coding changes. It may not be reported with psychotherapy or non-face to face prolonged care codes, or discharge services 99238, 99239, 99315, 99316. 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 David B. Glasser, MDSecretary, Federal Affairs, Michael X. Repka, MD, MBAMedical Director, Government Affairs, Joy Woodke, COE, OCS, OCSRDirector, Coding and Reimbursement, Matthew Baugh, MHA, COT, OCS, OCSRManager, Coding and ReimbursementHeather H. Dunn, COA, OCS, OCSRManager, Coding and Reimbursement. Whether its the changes CMS implemented to prolonged service coding with the 2023 final rule, or the different ways Medicare and payers who follow CPT guidelines code for prolonged services, things are getting tricky when trying to report these services. Note: For home and residence services and assessment of cognitive functions, see below. If the provider spends 30 additional minutes with the patient, report two units of G2212. This audit tool for modifier 25 will help determine if a separate E/M service should be reported. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. Last Updated Wed, 22 Mar 2023 12:22:35 +0000. Applications are available at the American Dental Association web site, http://www.ADA.org. Split/shared services Read More All content on CodingIntel is copyright protected. endstream endobj 328 0 obj <. Because Medicare's definition differs from. Providers continue to use CPT codes 99202 through 99205 to bill for E/M services for new patients, and CPT codes 99211 through 99215 for established patients. Remember G Codes for Medicare Patient Prolonged Services 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 (list separately in addition to CPT codes 99205, 99215, 99483 for office or other outpatient evaluation and management services). See our privacy policy. As a member of the 3M HIS team that creates and. For instance, time spent waiting on hold, leaving a message, etc., are not counted. LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright 2021, the American Hospital Association, Chicago, Illinois. G2212 effective January 1st, 2021. The scope of this license is determined by the AMA, the copyright holder. MACs may be instructed to focus on specific codes or diagnoses, or even specific extra time units reported. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. Youll now be allowed to use it to report prolonged services with: CPT also deletes prolonged service codes +99356 and +99357 for 2023 and introduces another code: +99418 (Prolonged inpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time ), which had been previously give the placeholder code of 993X0. 1. The Centers for Medicare & Medicaid Services (CMS) has made several changes to how youll code prolonged services in the last few years. Receive Medicare's "Latest Updates" each week. CPT Code Description for 99417 G2212 effective January 1st, 2021. Although in general, I believe most clinicians can code for most of the work they do (not a universally held opinion, I know) this is a case where the claims must go to a coder for review. Applications are available at the AMA Web site, https://www.ama-assn.org. Reproduced with permission. The time reported must be 15 minutes, not 7.5 minutes. Don't use CPT codes to report these services. CMS is not using allowing practices to report G0316 when the time is 15 more minutes than the CPT typical time. Note: The information obtained from this Noridian website application is as current as possible. Retrieved from https://www.findacode.com/articles/how-to-properly-report-prolonged-services-using-99417-or-g2212-36784.html. Learn how to get the most out of your subscription. Criteria for Using and Submitting CPT Code G2212: Primary E/M service CPT Code 99205 or 99215 is selected based on time and NOT medical decision making and the service was 15 minutes or more Services must be Medically Necessary during the prolonged E/M service. For both, howevever, you can only count time that requires practitioner knowledge and expertise. Could we use G2212 or 99417 on 99441 - 99443 CPT codes? Legal issues: If the provider had to defend themselves in a court case it could be very important for them to be able to easily identify the services, education, advice, or recommendations that were discussed during the encounter. The prolonged codes can only be used on 99205 and 99215, and only when time is used to select the office visit code. (Do not report G0318 for any time unit less than 15 minutes)). CMS DISCLAIMER. CPT instructs you to use +99417 when service times for 99205 (Office or other outpatient visit for the evaluation and management of a new patient 60-74 minutes of total time is spent on the date of the encounter) or 99215 (Office or other outpatient visit for the evaluation and management of an established patient 40-54 minutes of total time is spent on the date of the encounter) go 15 minutes beyond the minimum for the 99205/99215 time ranges 75 minutes for a new patient visit and 55 for an established patient and additional units for every 15 minutes beyond those times. For 2023, CPT removes the words beyond the minimum required time from the descriptor for +99417, which now reads (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)). Additionally, be sure to clearly document the amount of time . CMS does not recognize 99417 for Medicare Advantage members. Yes. This makes no sense. (Do not report 99417 on the same date of service as 90833, 90836, 90938, 99358, 99359, 99415, 99416) The CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. Medicare & Payers Adopting Medicare Guidelines. These are important qualifiers, as medical necessity audits are likely to follow. Get Info on New +99417 CPT Updates Remember that these codes may only be reported with 99205 or 99215. CDT is a trademark of the ADA. End Users do not act for or on behalf of the CMS. The Centers for [], To avoid confusion over code choice for your Medicare and private payer patients, and to [], Count This Instead of Shots for Accurate TPI Tally, Heres why the number of overall shots is irrelevant to your code choice. You cant report the new add on code on the same day as psychotherapy, non-face-to-face prolonged care codes 99358, 99359 or staff prolonged care codes. To align TRICARE policy with Medicare policy, providers should use HCPCS code G2212 (each additional 15 minutes, but not less than 15 minutes), when billing for prolonged services in addition to Current Procedural Terminology (CPT) codes 99205, 99215 or 99483. The information below is what was sent to us from our Medicaid program. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. When the time of the reporting practitioner is used to select the office/outpatient E/M visit level, HCPCS code G2212 could be reported when the maximum time for the highest level (level five) office/outpatient E/M visit (99205 or 99215) is exceeded by at least 15 minutes on the date of the service. It included reviewing test results, documenting in the record and arranging for follow up at pain management. Information provided by our coding experts is copyrighted by the American Academy of Ophthalmology and intended for individual practice use only. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. 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 (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services), (Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). Watch this webinar about all these changes. Does anyone have any concrete information regarding these additional codes we can use for prolonged E/M Services. It includes time for some services on the days before or after the face-to-face encounter. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. It doesnt follow CPT typical times, or CPT prolonged services rules. The typical time for this code is 60, making the threshold time to add a prolonged care code 75 minutes. No fee schedules, basic unit, relative values or related listings are included in CDT. Its the place for leaders to [], March 29, 2023 / By Garri Garrison, Kelli Christman, I sat down with the 3M Health Information Systems Division President Garri Garrison to talk about the upcoming HIMSS show in Chicago and what you can expect at the 3M [], Barbara Aubry, RN, CPC, CPMA, AAPC Fellow, CHCQM, FABQAURP is a senior regulatory analyst for 3M Health Information Systems. Same-Day Admission/Discharge (99236), IP/Obs. G0316 Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using 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 (list separately in addition to CPTcodes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents.
