Page xvi of the CPT Professional Edition 2023 states, Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a standalone code. It is easy to ignore the information in the introduction of the CPT book but when Im stuck, I regularly find answers there. According to CPT and HCPCS, prolonged service codes 99354-99357, 99359, 99415-99416, 99437, 99439 and G0513-G0514, G2212 are considered add-on codes and should not be reported without the appropriate primary code. Please be aware that this information may be stored on a server located in the U.S. 99345/99350 (Home or residence visit for the evaluation and management of a new/established patient ) when the times meet or exceed 75 or 60 minutes, respectively 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). End users do not act for or on behalf of the CMS. This system is provided for Government authorized use only. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. It may not display this or other websites correctly. HCPCS code G2212 is as follows, "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 Applications are available at the American Dental Association web site, http://www.ADA.org. 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. These are important qualifiers, as medical necessity audits are likely to follow. Remember G Codes for Medicare Patient Prolonged Services Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Medicare and the AMA do not agree on how to define the time factors of "prolonged service". It also included an extensive discussion with the patient and his sister about treatment options and recovery time, if he decides on surgery.. Everyone loves to read the general guidelines at Read More "Breathe in, Breathe out": CPT Coding for Read More Coding for hospital services (2021, February 3). Prolonged home or residence 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 99345, 99350 for home or residence evaluation and management services). Barbara Aubryis a senior regulatory analyst with 3M Health Information Systems. CodingIntel was founded by consultant and coding expert Betsy Nicoletti. 4. It will be reimbursed by Medicare at a national rate of $15.88. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). CMSs manual does not currently require start and stop times. endstream endobj startxref Transfer of Care: If the patient's care was being transferred to another provider, the information contained within this record describing the services, recommendations, treatments or other issues would be of great value. Helps here: This article will discuss all the new codes, and coding conventions, that are part of prolonged services coding in 2023. CPT allows you to add the 15 minutes to the lower time threshold in the range, and CMS requires you to add the 15 minutes to the higher time threshold in the range. CPT Code Description for 99417 Note: The information obtained from this Noridian website application is as current as possible. The CPT Editorial Panel's guidance was that prolonged services could be billed after a visit exceeds the minimum level 5 threshold by 15 minutes. It includes time for some services on the days before or after the face-to-face encounter. For other services (hospital, nursing facility and home and residence services), CPT uses the times stated in the CPT book for the primary code when calculating if a prolonged services code may be added. These valuations were finalized with an effective date of January 1, 2021. If the patient has private insurance, you would bill 99223 and +99418 as +99418 may be used as soon as the total time [75 minutes] has been exceeded by 15 minutes, according toKelly Loya, CPC, CHC, CRMA, CPhT, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina. else{document.getElementById("usprov").href="/web/"+"jeb"+"/help/us-government-rights";}, Advance Beneficiary Notice of Noncoverage (ABN), Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), Medicare Diabetes Prevention Program (MDPP), Diabetic, Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT), Fee-for-Time Compensation Arrangements and Reciprocal Billing, Independent Diagnostic Testing Facility (IDTF), Documentation Requests: How, Who and When to Send, Medical Documentation Signature Requirements, Supplemental Medical Review Contractor (SMRC), Unified Program Integrity Contractor (UPIC), Provider Outreach and Education Advisory Group (POE AG), PECOS and the Identity and Access Management System, Provider Enrollment Reconsiderations, CAPs, and Rebuttals, CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.15, CMS Medicare Learning Network (MLN) Matters (MM) 12071, click here to see all U.S. Government Rights Provisions, American Hospital Association Online Store, Do not report G2212 on the same date of service as 99415, 99416, Do not report G2212 for any time unit less than 15 minutes. Required fields are marked *. Your email address will not be published. For hospital, nursing facility and home and residence services, CMS uses time on other dates of service. Even though CMS instructs providers to use G codes, there will be no additional payment for G2211 until January 1, 2024 or later; it is currently considered a bundled service. * Time must be used to select visit level. Instead, use G2212, G0316, G0317, and G0318 . The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. The following codes are covered and separately reimbursed when documentation requirements are met: G2212Prolonged 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 (G2212) Do you have any recommendations about how to manage this in the office? Last Updated Wed, 22 Mar 2023 12:22:35 +0000. For more about Betsy visit www.betsynicoletti.com. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. 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 CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). Helps here: This article will discuss all the new codes, and coding conventions, that are part of prolonged services coding in 2023. When they were applicable to all levels of service, the threshold time was different for each code. 5. 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)). MPFS Conversion Factor a Tough Pill for 2023, Unless Congress acts, CF will be significantly cut. In their place, youll now use +99417, as CPT has increased its scope. CPT is a registered trademark of the American Medical Association. Use HCPCS Code G2212. CMS uses highest value in time range for CPT codes. Feb. 15, 2021 / By Barbara Aubry, RN. Thank you for choosing Find-A-Code, please Sign In to remove ads. CPT allows with consults. Does anyone have any concrete information regarding these additional codes we can use for prolonged E/M Services. 371 0 obj <>stream The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Unauthorized or illegal use of the computer system is prohibited and subject to criminal and civil penalties. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA is a third-party beneficiary to this Agreement. Visit aao.org/codingfor the most recent updates. 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. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Practitioners should not report prolonged office/outpatient E/M visit time using CPT codes 99354 and 99355 (Prolonged service with direct patient contact), 99358 and 99359 (Prolonged service without direct patient contact), 99415 and 99416 (Prolonged clinical staff services), or 99417 (Prolonged office/outpatient E/M services with or without direct patient contact), 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 (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services). As a member of the 3M HIS team that creates and. Example: An established patient, high risk E/M service took a total of 68 minutes. 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 How to Apply HCPCS G2212 in CA Workers' Comp | daisyBill But, they may not be reported on the same date of service as 99202-99215 per CPT. 354 0 obj <>/Filter/FlateDecode/ID[<91A2005DF854F64E856D6A7174D11ED9>]/Index[327 45]/Info 326 0 R/Length 121/Prev 260514/Root 328 0 R/Size 372/Type/XRef/W[1 3 1]>>stream Discharge Day Management (99238-9), 1 day before visit + date of visit +3 days after, 3 days before visit + date of visit + 7 days after, Cognitive Assessment and Care Planning (99483). We do not expect reporting of HCPCS code G2211 when the office/outpatient E/M visit is reported with payment modifiers such as a modifier -24, -25 or -53. *IMPORTANT NOTE: The new add-on prolonged services codes G2212 and 99417 will NOT BE EFFECTIVE UNTIL 2021; do not use these new codes for services prior to January 1, 2021. LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) (Do not report 99418 for any time unit less than 15 minutes). Note: For home and residence services and assessment of cognitive functions, see below. Billing For Dementia Care 2021 - CAPC Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service), Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service). However, Medicare does not cover 99417 and, instead, created HCPCS code G2212 to report this service. Since E/M services are such a large volume of the claims processed, CMS may choose to hire outside auditors. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. var url = document.URL; CA OMFS: E/M Billing - 2021 Major Changes | daisyBill HCPCS code G2211 may be reported with any visit level. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. It appears CMS may be using this add-on code to document care that includes use of care teams including use of community resources to meet social determinants of health, such as access to reliable transportation. The Centers for Medicare & Medicaid Services (CMS) has made several changes to how youll code prolonged services in the last few years. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). The scope of this license is determined by the ADA, the copyright holder. Providers must spend an entire 15 minutes providing E/M services for each unit of G2212 billed. And, there is not a replacement code for this service for Medicare. hb```f``;Ab,fk27Xs&Y \-2=nqgm Learn how to get the most out of your subscription. The non-face-to-face prolonged care codes are still active, billable codes. CMS is allowing time on after the date of the encounter to be used for prolonged services in relation to hospital services. The AMA is a third-party beneficiary to this license. o New CPT code 99417 can be reported for each 15 minutes of prol onged care performed on the same day beyond the maximum time listed for E/M codes 99205 and 99215. CMS: How to properly report the E/M add-on G codes Add This New CPT Prolonged Service Code Document How Physician/QHPTime Was Spent. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Office/Outpatient E/M Codes | ACS She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. (Do not report 99418 on the same date of service as 90833, 90836, 90838, 99358, 99359) CMS is allowing time on days prior to and after the date of the encounter to be used for prolonged services in relation to home/residence visits. It may not be used with Emergency Department codes. Reasonable coders and practitioners can and do disagree about when a separate E/M service is warranted on the day of a minor procedure. Using it consistently will help practices be reliable in their determinations and provide support in payer audits. 3M and its authorized third parties will use the information you provided in accordance with our privacy policy to send you communications which may include promotions, product information and service offers. registered for member area and forum access, 99205 and G2212 (3 units or more for each additional 15 minutes), 99215 and G2212(3 units or more for each additional 15 minutes). Find-A-Code Articles. For 2023, CPT also deletes prolonged service codes +99354 and +99355. The full 15 minutes is required and time must have been used to select the level of service. CPT uses lowest value in time range, CMS uses highest value in time range. The time reported must be 15 minutes, not 7.5 minutes. Youll now be allowed to use it to report prolonged services with: Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Health information management (HIM) professionals are [], Each year 3M brings together some of the brightest minds in health care, clinical documentation and health information management at our annual 3M CES. Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role. Remember that these codes may only be reported with 99205 or 99215. An add-on code must be submitted with its primary code. Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. 2. For 2023, CPT also deletes prolonged service codes +99354 and +99355. The 2021 Medicare Payment and CPT Coding Update | AAFP PDF 2021 coding changes for E/M office visits - Magellan Provider (Do not report G2212 for any time unit less than 15 minutes)).. PDF Physician Fee Schedule (PFS) Payment for Office/Outpatient Evaluation Forewarned is forearmed as they say. This warrants a quick review of the guidelines and criteria required for reporting this prolonged E/M service, as follows: Prolonged Codes Specific to 99205 and 99215: For private payers who do not follow the Medicare guidelines, the appropriate code for reporting prolonged E/M services for office or other outpatient E/M services is 99417. For both, howevever, you can only count time that requires practitioner knowledge and expertise. Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, RetinaBiosimilars, Dual Inhibitors, and Coding for New Drugs, Boost Your MIPS Score: Pitfalls to Avoid, Tips to Follow, Cataract Comanagement ComplianceCMS Outreach Prompts Internal Reviews, MIPS 2023Quality Measure Benchmark Summaries, MIPS 2023Key Dates for Performance Year 2023, 2023 Fundamentals of Ophthalmic Coding Course (Live Virtual), 2023 Fundamentals of Ophthalmic Coding Course (Recording), Fundamentals of Ophthalmic Coding Course (Virtual), 2023 IRIS Registry (Intelligent Research in Sight) Preparation Kit, 2023 Codequest Virtual - Multistate (Recorded March 28), 2023 Coding Coach: Complete Ophthalmic Coding Reference, 2023 CPT: Complete Pocket Ophthalmic Reference, 2023 Retina Coding: Complete Reference Guide, 2023 Coding Assistant: Cataract and Anterior Segment, 2023 Coding Assistant: Pediatrics/Strabismus, Ophthalmic Medical Assisting: An Independent Study Course, Essentials of Ophthalmic Nursing kit RVSD (V1-V4), 2023 ICD-10-CM for Ophthalmology: The Complete Reference, 2022-2023 Basic and Clinical Science Course, Complete Print Set, 2022-2023 Basic and Clinical Science Course, Complete eBook Set, 2022-2023 Basic and Clinical Science Course, Complete Print and eBook Set, 2022-2023 Basic and Clinical Science Course, Residency Print Set, 2022-2023 Basic and Clinical Science Course, Residency eBook Set, International Society of Refractive Surgery. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. 0 You can see the chart from the CMS final rule and read about it here. I think the question was prompted by the fact that for certain services provided by practitioners in a facility the add-on prolonged care codes includes time the days before or in the days after the face-to-face encounter. Revenue Code Descriptor . It included reviewing test results, documenting in the record and arranging for follow up at pain management. The prolonged codes can only be used on 99205 and 99215, and only when time is used to select the office visit code. Please click here to see all U.S. Government Rights Provisions. Both codes describe a prolonged office or other evaluation and management service that requires at least 15 minutes or more of time either with OR without direct patient contact on the date of the primary E/M service (either CPT codes 99205 or 99215). Even though G2211 is considered bundled and not separately reimbursable until at least 2024, it is important to report it on claims with a zero charge. Extend Prolonged Service Smarts With New Codes : E/M 2023 Fortunately, the guidelines for using the code remain the same. 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. Consistent with CPTs approach, we do not assign a frequency limitation. 99418 may be used on the highest-level initial and subsequent inpatient and observation codes, inpatient consult, and initial and subsequent nursing facility services. Prolonged services in a nursing facility: CPT code 99418/HCPCS code for Medicare G0317. (Do not report 99417 on the same date of service as 90833, 90836, 90938, 99358, 99359, 99415, 99416) Could we use G2212 or 99417 on 99441 - 99443 CPT codes? To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. Effectively, all prolonged services coding will need to be done by coders. PDF 2021 Evaluation and Management Changes: New Prolonged Services Codes 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). Get timely coding industry updates, webinar notices, product discounts and special offers. Cancel anytime. HCPCS Code for Prolonged office or other outpatient evaluation and CMS does not recognize consult codes. 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. The AMA assumes no liability for the data contained herein. I understand from your article about prolonged services in 2021 that CMS wont pay for prolonged code 99417 and instead developed a HCPCS code for the service. G2212 is a valid 2023 HCPCS code for 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 When can I bill prolonged services code 99417? The definition of 99417 is above. G2212/99417 | Medical Billing and Coding Forum - AAPC First, consult the Clip & Save guide elsewhere in this article, then determine how you would code for inpatient care lasting 95 minutes for a patient who has just been admitted to the hospital. Providers may bill G2212 only when choosing the level of E/M services based on time, not MDM. y{O? %vYt{D&P*iI 00v3f|ti!lL3>"A@^N]LV``>rg "MUc`ZQ` a She has been a self-employed consultant since 1998. Medicare & Payers Adopting Medicare Guidelines. 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)). If the provider spends an additional19 minutes (or any value less than double or triple (etc) 15 minutes) with a patient, report only one unit of G2212.