Code 99417 describes prolonged outpatient E/M service time with or without direct patient contact beyond the required time of the primary service. Furthermore, time spent on a date other than the date of service shouldnotbe counted toward total time. Code 99318, previously used to describe an annual nursing facility assessment, will be deleted. Referring and communicating with other health care professionals (if not separately reported). Modifier 25 tips. When was the last major change to the EM section of coding? By clicking Accept, you consent to the use of ALL the cookies. 0000002495 00000 n However, as noted below, if the physician receives the test results from another physician (e.g., the radiologist who interpreted the X-ray), the physician providing the E/M service may count the review of those results as part of MDM. 295 0 obj <> endobj For example, if the physician allows the patient to call a spouse to relate the information, the time spent contacting the spouse and obtaining the history may make the encounter longer than usual. 342 0 obj <>stream In accordance with CMS and the AMA, Prolonged Services without Direct Patient Contact (CPT codes 99358-99359) will not be separately reimbursed when reported with CM CPT codes 99417,99484, 99487, 99489, 99490, 99492-99494, G2058 and TCM CPT codes 99495 and 99496. <>stream Data that did not impact the assessment and treatment of the patient does not need to be copied into the note. He is the current chair of the AAOS Committee on Coding Coverage and Reimbursement. 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 . 0000003984 00000 n The code can be reported for each incremental 15-minute period. 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. Examples include but are not limited to prescription management, social determinants of health, and decisions regarding surgery. %PDF-1.7 This website uses cookies to improve your experience while you navigate through the website. For repeat laboratory tests performed on the same day, use modifier 91. Your documentation should be sufficient to support the level of service billed. 2023 FAQS Clear - All Rights Reserved Denied Telehealth billing for EM code with 99417. Communicating with the patient, family, and/or caregiver(s). The provider must have E/M in their scope of practice, so social workers and other types of therapists may not use it. The CPT Panel made additional modifications to the prolonged services codes. 0000001882 00000 n Is it only Medicare or both Medicare Advantage plans?" %%EOF UnitedHealthcare reimburses Prolonged Services when reported with E/M codes in which time is a factor in determining level of service in accordance with CPT and or HCPCS guidelines. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 29881 procedures. <> 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. We apologize for the inconvenience. This website and its contents may not be reproduced in whole or in part without written permission. Does United Healthcare cover prolonged services? This code is listed in addition to the inpatient or observation E/M code. Yes, if the physician documents it appropriately. Instead, CMS released HCPCS code G2212 to be used when billing 15 minutes of prolonged services for Medicare, including Medicare Advantage members. Questions and Answers [RgrD$"HA)EVt=^S_\f%La(o5z(ztwj2P&a Oeqc\FzOz=Ica,&( w1,(3&PL S:$C)s#. 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. x][s~wan\%_$}brLB"*?(avSX@|3=}yS_&ziE_Ng<9~]|*/i ~UWoD'?g??K$NT%EQVh^=?Dv8wQh+ ? The "Allowable Modifiers" column refers to services or procedures that may use certain allowable modifiers to indicate that the procedure or service has been altered by some specific circumstance but not changed in its definition or code. Inpatient and Observation Care ServicesThe inpatient and observation code categories are now combined. PDF Preventive Medicine and Screening Policy, Professional - UHCprovider.com Do not append Modifier 25 to an E/M unless the level of service can be supported as going above and beyond. Hello Coders! Provider wanting to bill CPT code 25075 X 3 , 99215, 99417 x2 . 2 0 obj Your email address will not be published. 2021 E/M coding and documentation rules - ACAAI Member virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor . Get answers to your coding and billing questions for these EM visits. Your documentation should reflect the actual time spent for each encounter.