Understand how and when to apply the new Prolonged Codes.
With the launch of the new E/M guidelines, we now have two different Prolonged Codes to use. That’s a result of the different calculations defined by the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) Final Fee Schedule. While CPT® instructs us to use code 99417, CMS instructs us to use HCPCS code G2122.
This divergence has left many of us coders and auditors scratching our heads trying to understand the lingering questions and uncertainty around how to properly apply these guidelines. Does the AMA and CMS define total visit time differently? Do we use the total visit time or the usual time? When should we apply the CPT® code, and when should we apply the CMS code for prolonged times?
In order to ensure proper coding and payment of E/M services for our organizations, we need to answer each of these questions. Which is why we wrote our newest eBrief, “Setting the Record Straight: Using the 2021 E/M Time Calculation,” where we answer those questions and also eliminate the confusion surrounding time-based coding by demonstrating how you can:
- Master the New 2021 Office/Other Outpatient E/M Guidelines
- Understand How and When to Apply the New Rules
- Work with Your Providers to Ensure Documentation Stands Up to Scrutiny