G2212 and 99417, Do You Know the Difference?

April 2, 2021

2021 Brought in a new year and new guidelines. We learned about the 2021 office visit E&M guidelines and what those changes meant, as well as the addition of codes to accommodate prolonged services when time-based coding.

The codes both describe prolonged services to be used once the maximum specified time for level 5 office visit has been surpassed. However, as you can see there is one minor detail that adds up to a big difference.

99417 AMA

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)

G2212 CMS

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 additional15 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)

Both codes are to be used only with the 99215/99205 and when you use them is the key difference outside of who you bill them to. Here you can see a reference chart for time-based coding and when you can start to report prolonged services based on the use of either code.

 

Total duration of New Patient Office or other outpatient services(use with 99205)

Code(s)

less than 75 minutes

Not reported separately

75-89 minutes

99205 X 1 and 99417x1

90-104 minutes

99205 X 1 and 99417x2

105 or more

99205 X 1 and 99417x3 or more for each additional 15 minutes.

Total duration of Est. Patient Office or other outpatient services (use with 99205)

Code(s)

less than 55 minutes

Not reported separately

55-69 minutes

99215 X 1 and 99417x1

70-84 minutes

99215 X 1 and 99417x2

85 or more

99215 X 1 and 99417x3 or more for each additional 15 minutes.

*A reminder as well, time based verbiages need not conform to the former “>50%” verbiage but rather a summary of total time and what it was spent doing, or if preferred an itemized amount of time statements per task.

 

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