We are often asked about how to manage prolonged patient visits when it comes to billing and coding. It is important to remember that you must have a true clinical reason for the prolonged visit and the documentation to support the extended care.
We will review a few different types of codes to use with prolonged or extended patient visits.
Prolonged office E/M visits
If you see a patient and exceed the maximum time for a level five office E/M visit by at least 15 minutes on the date of service then you can use the code G2212. This code was established by CMS and is most often used by Medicare payers. Sometimes commercial payers accept G2212 instead of 99417. 99417 is the other add-on code that is added to either a 99215 or 99205 visit. The difference is that 99417 can be billed exactly one minute after the time threshold for the level 5 exam is over, but this code is not accepted by Medicare. HCPCS code G2212 is to be used for billing Medicare for prolonged office/outpatient E/M visits instead of CPT codes 99358, or 99359 for dates of service on and after January 1, 2021.
Essentially you use this alongside 99205 or 99215. Remember, do not use G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, and 99416.
Face-to-Face Patient Contact
The following codes are used when a physician (or other health care professional) spends time beyond the usual evaluation and management (E/M) service in either the inpatient or outpatient setting. Since 2021, these codes have very limited use and are primarily for use when the time for codes 99241-99245 is extended or other rare codes. These are no longer used as add-on codes to 99205/99215.
- 99354: Prolonged E/M in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour
- 99355: Each additional 30 minutes (list separately in addition to code for prolonged service)
- 99356: Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour
- 99357: Each additional 30 minutes
Without Face-to-Face Contact
These codes are really for interacting with patients that are not face-to-face. These are NOT add-on codes, they may be reported alone but the documentation must identify them as related to an E/M encounter. These are often happening before or after the E/M visit to manage care.
- 99358: Prolonged E/M before and/or after direct patient care; first hour
- 99359: Each additional 30 minutes (list separately in addition to code for prolonged service)
Please remember that these codes cannot be used in the same service period as chronic care management (CCM). If there are more specific non-face-to-face care CPTs then you should use those. These codes are to be used for qualified physicians or advanced practitioners (i.e. not nurses or other nursing staff). These codes can also not be used with other E/M codes that qualify for CCM visits. See below for those.
Do not report 99358 or 99359 for a prolonged service related to 99202-99215on the same day as the E/M service. That is when you should use code G2212. It is reported exclusively for prolonged services on the same day as 99202-992215 and is ONLY reported with the level 5 exam.
If the prolonged service 99358 occurs on a date other than the day the E/M service was performed, it may be correlated with any level of E/M service 99202-99215.
It is extremely important to get prolonged service codes right. Not only can it help with growing revenue but it is often a reason for getting audited. At National Revenue Consulting, we help practices with a reliable, data-driven service to help you grow your revenue.
Reach out today for a free consultation by one of our knowledgeable team members.
