Quote:
Originally Posted by Aces4
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.
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Short answer to first question: THEY DON'T. There is no "long visit" There is extent and complexity of visits. Here is the CPT description and documentation requirements for 99215:
What Does CPT Code 99215 Mean?
CPT code 99215 is specifically used to document a comprehensive evaluation and management service for established patients. To qualify for this code, the visit must meet the following criteria:
Comprehensive History: The patient’s history must be well-documented, including a detailed assessment of their medical condition, family history, and social history.
Comprehensive Examination: The physical examination should be thorough, covering all systems related to the patient’s presenting problems.
High Complexity Medical Decision-Making (MDM): The physician must demonstrate a high level of decision-making. This involves analyzing multiple diagnoses, reviewing test results, and determining complex treatment options.
Using this code appropriately ensures that healthcare providers are compensated for the time, effort, and resources required to manage complex patient conditions.
Documentation Requirements for CPT Code 99215
Proper documentation is key to successfully using CPT code 99215. It is essential that the documentation captures all three critical components: history, examination, and decision-making. Here’s a breakdown of what’s required:
Comprehensive History: This must include an extended history of present illness, an extended review of systems (ROS), and a complete past, family, and social history (PFSH). The history should be documented thoroughly to reflect the patient’s complex health status.
Comprehensive Examination: The physician must document a detailed examination of at least eight organ systems or body areas. All pertinent findings, whether normal or abnormal, should be included in the documentation.
High Complexity MDM: The documentation must show a high level of decision-making, including multiple management options, a thorough review of test results, and an assessment of patient risks and benefits for each treatment option considered.
Please point out, right from this excerpt from CPT, the word "long"
Now, as an aside, CPT does make statements that ARE NOT PART OF THE CRITERIA such as "this visit will typically take a physician xxx minutes to complete", which is a suggestion/guideline, but not part of the requirements. Also, when the strict documentation guidelines do not fit the service, there is a way to document time spent---the most obvious example is psychiatry where 50 minutes is spent "just talking", but bedside management in an ICU setting can also be billed by time.
Two other points that I will try to make politely:
1)
"Yeah, may be slightly over a billion... follow all the threads regarding this."
Yep, social media, the place to get all the facts
. If it's on the internet, it must be true???
2)
"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."
OK, that's your basis. My basis is using, documenting and reviewing these codes for 35 years. Please don't even think about equating the two.