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 CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. 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). As with all of these codes, both CPTand HCPCS, the prolonged code may only be added to the highest-level code in the category and then only when time is used to select the service. Start and end times, or total time, of the visit should be documented in the medical record along with the date of service. Prolonged services codes are add-on codes to E/M services. There are different CPT and HCPCS codes that describe the same prolonged care services. 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Table 20 below provides a summary of the codes and work RVUs finalized in the CY 2020 MPFS final You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Therefore, you have no reasonable expectation of privacy. 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). In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina. 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). The non-face-to-face prolonged care codes are still active, billable codes. Applications are available at the AMA Web site, https://www.ama-assn.org. Any and all information would be very helpful! Note: The information obtained from this Noridian website application is as current as possible. Sign up for our monthly newsletter to download the reference sheet. 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. When can I bill prolonged services code 99417? For instance, time spent waiting on hold, leaving a message, etc., are not counted. Naturally, they have three levels of edits but you can read about this on the CMS website. 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. (Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). CPT codes 99417 and 99418 are not accepted for processing for Commercial or Medicare Advantage plans. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Thirty-five minutes with a patient would be reported as two units of G2212, etc. Revenue Code Descriptor . For Medicare patients, there is a HCPCS code. Providers use Healthcare Common Procedure Coding System (HCPCS) Code G2212 to bill extended time for E/M services. by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MTFeb3rd,2021. 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. These are important qualifiers, as medical necessity audits are likely to follow. 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. Same-Day Admission/Discharge (99236), IP/Obs. 0760 Specialty Services General 0761 Treatment Room 0769 Other Specialty Services . CPT is a trademark of the AMA. End Users do not act for or on behalf of the CMS. Prolonged care services can no longer be used on psychotherapy codes. (Do not report G0318 for any time unit less than 15 minutes)). As expected, CMS is not recognizing the new CPTcode 99418. For both, howevever, you can only count time that requires practitioner knowledge and expertise. 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). If the patient's condition does not warrant a 99205 or 99215 level of care, then it does not matter how long the provider spent caring for the patient, G2212 technically should not be reported. CPT includes only time spent on the date of the encounter. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Recently, I discussed a couple of the more commonly encountered types of posterior instrumentation for spinal fusion procedures (posterior instrumentation). And, Medicare has given them a status code of invalid, which means they wont pay for it. For 2023, CPT also deletes prolonged service codes +99354 and +99355. var pathArray = url.split( '/' ); For Medicare, medical necessity is the overarching criteria, in addition to component scoring, used to determine the level of E/M service. Practitioners may report this code for qualifying visits furnished on or after January 1, 2021, although we assigned a PFS payment status indicator of B (Bundled) until 2024. The AMA assumes no liability for the data contained herein. It included reviewing test results, documenting in the record and arranging for follow up at pain management. 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. You can only use codes 99417 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. If the provider spends 30 additional minutes with the patient, report two units of G2212. 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 For CPT, use add-on code 99417 for prolonged care. The duration and the content of the evaluation and management code must . HCPCS code G2211 may be reported with any visit level. G2212 effective January 1st, 2021. (Do not report G2212 for any time unit less than 15 minutes) (Underlining is my addition.). CPT uses lowest value in time range, CMS uses highest value in time range. 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) . Please click here to see all U.S. Government Rights Provisions. 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. 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. The agency finalized new values for CPT codes 99202 through 99215 and assigned RVUs to the new office/outpatient E/M prolonged visit code G2212, as well as the new code G2211. CMS is allowing time on after the date of the encounter to be used for prolonged services in relation to hospital services. Otherwise, the actual billing codes for E/M services remain the same. It may not be used with Emergency Department codes. The disagreement stems from whether to start counting the 15 minutes of prolonged care at the minimum time threshold for the code or the maximum time threshold. 99231 -99233 Evaluation and Management Services 99 238 -99499 Evaluation and Management Services For the 2023 final rule, CMS has taken a similar view of +99418, believing that the billing instructions for the code would lead to administrative complexity, potentially duplicative payments, and limit our ability to determine how much time was spent with the patient using claims data. In its place, they have introduced three more G codes: 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. 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. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos. 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). The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. CodingIntel was founded by consultant and coding expert Betsy Nicoletti. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. By continuing beyond this notice, users consent to being monitored, recorded, and audited by company personnel. Since E/M services are such a large volume of the claims processed, CMS may choose to hire outside auditors. This license will terminate upon notice to you if you violate the terms of this license. 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. 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. 99233 (Subsequent hospital inpatient or observation care 50 minutes must be met or exceeded) 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). Expect audits of all E/M claims that use time as the determining factor in choosing a code. 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. Learn more about solutions from 3M Health Information Systems. 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 Find-A-Code Articles. 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. It may not be reported with psychotherapy or non-face to face prolonged care codes, or discharge services 99238, 99239, 99315, 99316. 2. Below are a few excerpts that I would like to highlight. You may also contact AHA at ub04@healthforum.com. CMS created HCPCS codes when billing Medicare for prolonged Evaluation and Management (E/M) services which exceeds the maximum time for the highest level (99205, 99215, 99223, etc.) The information below is what was sent to us from our Medicaid program. 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. Prolonged service time can be reported when furnished on any date within the primary visits surveyed timeframe, and includes time with or without direct patient contact by the physician or NPP. Split/shared services Read More All content on CodingIntel is copyright protected. (2021, February 3). Last Updated Wed, 22 Mar 2023 12:22:35 +0000. 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). We NEVER sell or give your information to anyone. 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. It includes time for some services on the days before or after the face-to-face encounter. coding guidance prior to the submission of claims for reimbursement of covered services. Example: An established patient, high risk E/M service took a total of 68 minutes. All rights reserved. Remember G Codes for Medicare Patient Prolonged Services 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). In their place, youll now use +99417, as CPT has increased its scope. 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. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. 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. The scope of this license is determined by the AMA, the copyright holder. E/M 2023: Extend Prolonged Service Smarts With New Codes, Extend Prolonged Service Smarts With New Codes, 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, Fortunately, the guidelines for using the code remain the same. Use CPT code times on the date of service only, Use time three days before visit, date of visit and 7 days after visit. JavaScript is disabled. hbbd```b``O@$~f+ `5_U0y^f>&o_ RXDu%!2H>j -Wx $A? /p Do not report G0316 for any time unit less than 15 minutes. 5. CPT codes 99417 and 99418 will be denied with one of the following: Denial explanation code: 53B This procedure code is not accepted for processing by Moda Health for Thank you! In addition to the highest-level initial and subsequent nursing facility care E/M codes 99306 and 99310, youll use +99418 with the following revised codes: Remember G Codes for Medicare Patient Prolonged Services. 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. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. According to CMS: Trying to become comfortable with new codes is always a challenge and these added requirements are a bit confusing. Do not report G0318 on the same date of service as other prolonged services for evaluation and management. CMS does not recognize 99417 for Medicare Advantage members. What about the extra 15 min from 54-69 minutes? Because Medicare's definition differs from. 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. 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. These are added in 15-minute increments in addition to codes 99205 or 99215. These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). 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. Prolonged services for labor and delivery are not separately reimbursable services. Providers must spend an entire 15 minutes providing E/M services for each unit of G2212 billed. Use the prolonged services code 99417 fornon- Medicare Advantage members. Retrieved from https://www.findacode.com/articles/how-to-properly-report-prolonged-services-using-99417-or-g2212-36784.html. Check Out This Clinical Scenario 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. Instead, use G2212, G0316, G0317, and G0318 . 371 0 obj <>stream G2212 Prolong outpt/office vis 0.96 $32.24 0.97 $33.85 -4.7% 0.93 $31.23 0.93 $32.45 NEW CODE . The use of the information system establishes user's consent to any and all monitoring and recording of their activities. MPFS Conversion Factor a Tough Pill for 2023, Unless Congress acts, CF will be significantly cut. The ADA expressly 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. CMS uses highest value in time range for CPT codes. In the 2021 final rule, CMS argued that you should use +99417 when the total time for visits hits 15 minutes beyond the maximum time range for 99205 (i.e., 89 minutes) and 99215 (i.e., 69 minutes). All rights reserved. *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. CMS uses claims data to make future reimbursement and fee schedule decisions, so it is always important that codes such as this make it into the data base. Bone Up on +99417 Definition Warning: you are accessing an information system that may be a U.S. Government information system. How To Properly Report Prolonged Services Using 99417 or G2212. Once the total time has been calculated, and the service level has been determined to be high risk, then subtract either the 74 minutes (. CMS added two HCPCS codes to represent additional time for E/M services. 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). This is in the CPT and HCPCS definition of prolonged services. 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. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. The full 15 minutes of prolonged services must be met. 99223, 99233 use time only on date of visit. Fortunately, the guidelines for using the code remain the same. CMS has given them a status indicator of invalid and doesnt pay for them. 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.

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