Per CPT, use 99417 for office visits, outpatient consults, home and residence services and cognitive assessment planning. care coordination (not separately reported).independently interpreting results (not separately reported) and communicating results to the.documenting clinical information in the electronic or other health record.referring and communicating with other health care professionals (when not separately reported). ordering medications, tests, or procedures.counseling and educating the patient/family/caregiver.performing a medically appropriate examination and/or evaluation.obtaining and/or reviewing separately obtained history.preparing to see the patient (eg, review of tests).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.Ī practitioner may include these activities in their time, when using time to select an E/M service: However, CMS and the AMA are not in agreement about the use of prolonged care code 99417, resulting in HCPCS code. 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 CPT ® book. Use for time spent face-to-face and in non-face-to-face activities.If using either code, only report it with codes 9925, use only clinician time, and use it only when time is used to select the code.Medicare has assigned a status indicator of invalid to code 99417, and developed a HCPCS code to replace it, G2212.The AMA developed CPT ®code 99417 for 15 minutes of prolonged care, done on the same day as office/outpatient codes 9925.These codes and rules have been in effect since 2021. Note: For home and residence services and assessment of cognitive functions, see below.Ĭoding for prolonged services is complicated by the fact CPT ® and CMS use different codes and different time thresholds. CPT allows with consults.ĬMS uses highest value in time range for CPT codes. There is no replacement of these services for Medicare patients.Ĭoding prolonged services in the office Office servicesĬPT uses lowest value in time range, CMS uses highest value in time range. CMS has given them a status indicator of invalid and doesn’t pay for them. CPT® still has non-face-to-face prolonged care in the CPT® book, codes 99358, +99359 which can be used on days that do not include a face-to-face visit. For hospital, nursing facility and home and residence services, CMS uses time on other dates of service.
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