Prolonged time codes 99417 and G2212

Q:

I’m confused with time-based coding and counting prolonged time and differences between 99417and G2212.  Please help!

A:

Both codes are designed to be reported only when using time-based coding according to the new E/M guidelines and only with codes 99205 and 99215.  The conundrum is related to application differences between the AMA and CMS. The AMA developed code 99417 with instruction to report when the minimum threshold has been met plus 15 minutes.  CMS disagreed with reporting when only the minimum time has been met, and therefore CMS established code G2212, which is reported when the maximum threshold has been met plus 15 minutes. 

As an example, let’s use a new patient encounter that consumed 80 minutes total.  Code 99205 is defined as including 60-74 minutes.  The minimum threshold time is 60 minutes.  The maximum threshold time is 74 minutes. Our time-based patient encounter was 80 minutes total, a difference of 20 minutes from the minimum threshold time. 

For the non-Medicare patient, assign 99205 and one unit of 99417 as the total time has met the minimum threshold time plus 15 minutes.  

Medicare requires at least 15 minutes beyond the maximum threshold time of 74 minutes (a total of 89 minutes) before applying an add-on code of G2212. For an 80-minute encounter with a Medicare patient, only report 99205. 

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