Wiki Need help billing pro fee for extended visit with time

[Christal]

We saw a patient and we will be billing as time spent. This patient is a new patient and this will billed as a 99205 but the provider has 60 minutes over the 99205 spent with the patient. This patient has a Medicare HMO with UHC. Do I use the 99354 and will I add a modifier to the 99205 or 99354?

 

[jkyles]

99354 isn't used with office E/M visits. Since this is a Medicare Advantage plan I assume G2212 is appropriate: 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 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes).

No modifier required.

 

[Christal]

99354 isn't used with office E/M visits. Since this is a Medicare Advantage plan I assume G2212 is appropriate: 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 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes).

No modifier required.

Thank you

 

[csperoni]

As an aside, I've got to wonder what doctor has the time to spend over 2 hours on 1 patient. When I'm a patient, I'm usually rushed in and out in under 10 minutes. Maybe I need to use your physician!

 

[Christal]

As an aside, I've got to wonder what doctor has the time to spend over 2 hours on 1 patient. When I'm a patient, I'm usually rushed in and out in under 10 minutes. Maybe I need to use your physician!

We are a specialist office and this patient came in with severe difficulty breathing. She brought her own medical records that took our provider time to review. She had several test results to review plus the provider called another specialty group to get her an appointment today. The provider tried to get the patient to go to ER. This time is including time with the patient, research, and after the patient left with completing the chart and sending prescription in.