She knows what questions need answers and developed this resource to answer those questions. The total time must be documented. 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. Prolonged services codes may only be added to the highest-level code in the category. Your email address will not be published. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. Time is calculated ONLY for time spent on the day of the E/M encounter (not the day before or days following, even if additional services are provided on those days. CMS has edits in place to ensure that an add-on code is only paid when reported with a correct primary code. 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. Retrieved from https://www.findacode.com/articles/how-to-properly-report-prolonged-services-using-99417-or-g2212-36784.html. PDF Summary of Policies in the Calendar Year (CY) 2021 Medicare - CMS PDF REIMBURSEMENT POLICY Prolonged Services - Blue Cross MN In particular, the add-on prolonged services HCPCS codes developed by CMS. It doesnt follow CPT typical times, or CPT prolonged services rules. 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). Warning: you are accessing an information system that may be a U.S. Government information system. Providers use Healthcare Common Procedure Coding System (HCPCS) Code G2212 to bill extended time for E/M services. The non-face-to-face prolonged care codes are still active, billable codes. 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 (List separately in addition to the code of the inpatient and observation Evaluation and Management service), (Use in 99418 conjunction with 99223, 99233, 99236, 99255, 99306, 99310) In order to use prolonged care, the primary code must be selected based on time. As we learn more, we will continue to provide updates on this important topic. And wish I had started looking there in the first place! No fee schedules, basic unit, relative values or related listings are included in CPT. G0318(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). There is no replacement code. Just a few reminders. Billing for Prolonged Services - tricare-west.com For instance, time spent waiting on hold, leaving a message, etc., are not counted. 2021 Medicare physician fee schedule has good news for family - AAFP G2212 is to be used for billing the MPFS instead of CPT code 99358, 99359 or 99417, with the following descriptor: "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 CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. The AMA assumes no liability for the data contained herein. Any and all information would be very helpful! If, however, the patient's condition and the documentation supports a level five (99205 or 99215) level of service, and exceeds the upper limit of the time range, then HCPCS code G2212 would be reported. It is always important to properly document, but when a medical necessity audit is looming, be sure to include information that supports the decision making process. The 2021 Medicare Payment and CPT Coding Update | AAFP * Time must be used to select visit level. In other words, 1-14 additional minutes of E/M service does not warrant a unit of G2212. G0316 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service each additional 15 minutes ) for prolonged inpatient or observation E/M service codes 99223, 99233, and 99236 You may also contact AHA at [email protected]. In their 2021 Physician Fee Schedule Final Rule, CMS indicated its agreement with the new E/M definitions for codes 99202-99215 that were developed by the AMA that are in the 2021 CPTbook. For 2023, CPT also deletes prolonged service codes +99354 and +99355. Use CPT code times on the date of service only, Use time three days before visit, date of visit and 7 days after visit. When they were applicable to all levels of service, the threshold time was different for each code. Look for a description of what activities are included in the time, because this is required when using time to select the office visit codes. In their place, youll now use +99417, as CPT has increased its scope. CMS Disclaimer Effective January 1, 2021, CMS finalized HCPCS code G2212 for prolonged office/outpatient E/M visits HCPCS code G2212 is to be used for billing instead of CPT codes 99354, 99355, 99358, 99359 or 99417 Defined as prolonged office or other outpatient evaluation and management According to the AMA, the E/M work expense value already takes into consideration time spent caring for the patient (e.g., phone calls, prescriptions, questions, calling patient with test results) for the three days prior to and seven days following the actual E/M service, so if time spent performing these services was counted in addition to the time spent on the actual date of the encounter, this would be considered double dipping. *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. Do not report G0318 on the same date of service as other prolonged services for evaluation and management. The provider documented the service, including the severity of the patient's condition and decision to admit to the hospital based on EKGand chest x-ray findings positive for pneumonia. The following are a few reasons why instituting a best practice compliance policy of documenting what the physician/QHPspent their time doing with the patient is important: For more tips, coding scenarios, and resources for your E/M reporting, consider purchasing the2021 E&M Book Bundle. When a [], Allergic Arthritis Dx Nothing to Sneeze At, Question:Encounter notes indicate that a patient suffered from allergic arthritis, R ankle. Is this a [], Know Purpose of Shoulder Arthroscopy Before Coding, Question:Encounter notes indicate that the provider performed a level-four office evaluation and management (E/M) service [], Get Off on Right Foot With F/T Modifier Coding, Question:Im relatively new to orthopedic coding, so a couple of the modifiers Im familiarizing myself [], Copyright 2023. Thank you for choosing Find-A-Code, please Sign In to remove ads. Find-A-Code Articles. 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. Note that CMS allows the practitioner to include time spent three days before the date of the visit and seven days after. The ADA does not directly or indirectly practice medicine or dispense dental services. End Users do not act for or on behalf of the CMS. The prolonged codes can only be used on 99205 and 99215, and only when time is used to select the office visit code. 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). Prolonged services for labor and delivery are not separately reimbursable services. (Do not report G0316 for any time unit less than 15 minutes). 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. For CPT, use add-on code 99417 for prolonged care. 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. 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. 371 0 obj <>stream Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. 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. There is no replacement of these services for Medicare patients. endstream endobj startxref Do not report G0317 on the same date of service as other prolonged services for evaluation and management. 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. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. Please be aware that this information may be stored on a server located in the U.S. For 2023, CPT also deletes prolonged service codes +99354 and +99355. 99233 (Subsequent hospital inpatient or observation care 50 minutes must be met or exceeded) This blog focuses on types of anterior instrumentation for spinal [], Its Health Information Professionals Week and we want to take the time to thank all those who keep health information accurate, secure and accessible. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). A colleague said she was getting conflicting opinions about this. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. CPT codes 99358, 99359 or 99417 are not valid for Medicare with status indicator "I" on the physician fee schedule. For both, howevever, you can only count time that requires practitioner knowledge and expertise. Register for our on-demand E/M education series. The AMA CPT committee developed code 99417 for prolonged visits, and Medicare developed code G2212. 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. Effectively, it is so byzantine that most practices will never be able to bill for them. This license will terminate upon notice to you if you violate the terms of this license. The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. (Do not report G0317 for any time unit less than 15 minutes)). 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 All rights reserved. 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. 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 Properly Report Prolonged Services Using 99417 or G2212 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. This system is provided for Government authorized use only. G2212 effective January 1st, 2021. 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. Last revised March 14, 2023 - Betsy Nicoletti Tags: CPT updates, prolonged care. Users must adhere to CMS Information Security Policies, Standards, and Procedures. PDF Medicare Physician Fee Schedule Final Rule for Calendar Year 2021 - ACR Table 20 below provides a summary of the codes and work RVUs finalized in the CY 2020 MPFS final Recorded April Read More Download Reference Sheet 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. 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