General Surgery Coding Alert

Question: Documentation for a new patient office E/M service shows high-complexity medical decision making (MDM) and time of 87 minutes. Should we report this using the prolonged service code?

Minnesota Subscriber

Answer: No, the visit you describe doesn’t call for a prolonged service code.

To use the prolonged service add-on code for a new patient office evaluation and management (E/M) service, you must document the maximum time for the highest level E/M office code plus at least an additional 15 minutes. That would be 74 minutes plus 15 minutes for a total of 89 minutes, which would warrant using the following two codes:

• 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.)
• +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))

Because you document 87 minutes, you should report the service as 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).