General Surgery Coding Alert

Question: Our surgeon performed an extensive office evaluation and management (E/M) service for a new patient involving high-complexity medical decision making (MDM). The surgeon documented 84 minutes for the visit. Can I account for the extra time using the prolonged service code?

Connecticut Subscriber

Answer: No, you should not use the prolonged service code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)) in addition to the base E/M code for this case.

Instead: You should report only 99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/ or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.) for the service you described.

Here’s why: The descriptor for +99417 would not allow the code in this instance, because the surgeon didn’t reach the 15-minute threshold that the descriptor indicates you need. Unless the service lasted 89 minutes or more, you should not +99417.