Wiki Prolong office service cpt 99417

[RABBIT2020]

Established patient had office visit with ob-gyn.
Doctor documented note with 60 mins total time for the encounter.
The claim billed to a commercial payer were 99215+99417.
99417 was later determined to be inadequate for the time of the encounter.

Was 99215+99417 applicable for 60 mins est. Patient? Why or why not?

 

[shanamarie]

Established patient had office visit with ob-gyn.
Doctor documented note with 60 mins total time for the encounter.
The claim billed to a commercial payer were 99215+99417.
99417 was later determined to be inadequate for the time of the encounter.

Was 99215+99417 applicable for 60 mins est. Patient? Why or why not?

Yes, 60 minutes is correctly billed as 99215 & 99417. Minimum time needed is 55 minutes if they follow CPT guidelines.
If the payor follows MCAS then only 99215 should be billed. Minimum time for MCAS is 69 minutes. Each payor can decide which guidelines to follow, so you would need to check with each payor on this to see what they are following.