[Aces4]

Originally Posted by golfing eagles

Now this has gone from amusing to ridiculous. Here is the TRUTH, again, right from CPT for 99215. It's ridiculous that I have to re-post it when the wording couldn't be clearer, and the absence of the word "long" is obvious. You may have some cute little amateur explanation on the EOB that's "right in front of you", but there is no such code "Office visit, long".

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.

Also, ONCE AGAIN, the components required for 99215 are in CLEAR ENGLISH---and nowhere does it include "time spent on the encounter. GET IT----NOWHERE IS TIME SPENT ON THE ENCOUNTER PART OF THE CODING REQUIREMENT. AND AGAIN, REPEAT AFTER ME, THERE IS NO "DOCTORS VISIT, LONG CODE AND TIME IS NOT A FACTOR IN THE E&M CODES. And furthermore, this just goes to show the problem with AI----it's still garbage in, garbage out.

So, now I'm done responding to gibberish. If anyone has a legitimate question and wants to know more, just post it (except for one person)

PS: REPEAT AFTER ME, THERE IS NO "DOCTORS VISIT, LONG CODE AND TIME IS NOT A FACTOR IN THE E&M CODES.

If there is no Doctor's office visit, long code.. why the devil is Medicare using this verbage on their statements. Talk about gibberish, I guess the Medicare billing and Drs. offices need a new update on a 10 yr retired opinion of coding. This is laughable and I'm done too. People, the information is out there and if you're too old to figure out when Medicare may be overcharged by Drs. or their offices, you're out of luck. Speaking of luck, we're all going to need it after what I've read here.