Quote:
Originally Posted by golfing eagles
The usual billing codes have nothing to do with time. Physicians do not punch a time clock. There is no such thing as a "long" visit. The level of coding is determined by the extent of the medical history and physical exam along with the complexity of medical management. So basically, unless you have the progress note, know the E&M codes, and know how to apply them, you have absolutely no basis upon which to accuse him of "overbilling"
PS: and now we're up to $1 billion in "false" charges? Inflation?????
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Yeah, may be slightly over a billion... follow all the threads regarding this.
Then why does Medicare declare it to be a "long visit"? The extent of the visit was minimal, ten seconds of thyroid neck check, (didn't even have to swallow water this time), and was advised to reschedule in a year. That is my basis. At this age I am well aware of time allotted and the extent of service. The Dr. is very familiar with my history and, honestly, was more determined to get back on schedule than my office visit. You can schmooz it over and pad the services but they were so basic it was ridiculous. Maybe things have changed since you hung up your smock. AI: Yes, Medicare does distinguish between different levels of office visits, including "long" office visits, for payment purposes. Here's how Medicare addresses this: Office Visit Codes: Medicare uses Evaluation and Management (E/M) codes to classify office visits based on the level of complexity, medical decision-making, or the total time spent during the encounter. Prolonged Services: For visits that extend beyond the maximum time allocated for a standard Level 5 office visit (99205 for new patients and 99215 for established patients), Medicare utilizes a specific add-on code, G2212. G2212 - The Medicare Prolonged Services Code: This code is used when the total time spent by the physician or qualified healthcare professional on the date of service exceeds the maximum time for the highest level E/M visit (99205 or 99215) by at least 15 minutes. It is billed in 15-minute increments. Total time includes all the time spent by the reporting practitioner on the date of service, including face-to-face time and time spent on activities like chart review, documentation, communication with other professionals, etc., according to the American Academy of Family Physicians | AAFP Medicare's guidelines for prolonged services differ from the AMA's CPT code 99417, which some other payers might utilize. In essence, Medicare distinguishes longer office visits by requiring the use of a prolonged services code (G2212) in addition to the standard E/M code when the visit duration surpasses a specific threshold, ensuring appropriate reimbursement for extended care.