[biker1]

That is the exact wording I see. It comes on the EOB from my Supplemental Plan under Part B services. I don't really give it much thought, more of a curiosity to me. The most recent time I saw it, the appointment wasn't really that long. Perhaps "long" is not relative to time??

Originally Posted by Aces4

I've got my EOB right in front of me, "Doctor's office visit, long", but you are unable to accept any truth so maybe those reading this thread followers will realize the truth isn't always told by doctors. AI: the codes are based on the total time spent on the day of the encounter and the patient's status as new or established. For established patients, codes range from 99212 (shorter visits) to 99215 (longer, more complex visits).

[Aces4]

Originally Posted by biker1

That is the exact wording I see. It comes on the EOB from my Supplemental Plan under Part B services. I don't really give it much thought, more of a curiosity to me. The most recent time I saw it, the appointment wasn't really that long. Perhaps "long" is not relative to time??

Yes, it is. Established Patient Codes (Example) 99212: Typically 10-19 minutes 99213: Typically 20-29 minutes 99214: Typically 30-39 minute 99215: Typically 40-54 minutes. I allow for extra time for note taking, updating information and record research and there is no way my visit was a long one. I don't say all Drs. do this but I do think there is bill padding happening in some areas whether directly from the Drs. office or agency coding.

[golfing eagles]

Originally Posted by Aces4

I've got my EOB right in front of me, "Doctor's office visit, long", but you are unable to accept any truth so maybe those reading this thread followers will realize the truth isn't always told by doctors. AI: the codes are based on the total time spent on the day of the encounter and the patient's status as new or established. For established patients, codes range from 99212 (shorter visits) to 99215 (longer, more complex visits).

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.

[golfing eagles]

Originally Posted by Aces4

Yes, it is. Established Patient Codes (Example) 99212: Typically 10-19 minutes 99213: Typically 20-29 minutes 99214: Typically 30-39 minute 99215: Typically 40-54 minutes. I allow for extra time for note taking, updating information and record research and there is no way my visit was a long one. I don't say all Drs. do this but I do think there is bill padding happening in some areas whether directly from the Drs. office or agency coding.

Those times ARE NOT part of the criteria for an E&M code. REPEAT: THEY ARE NOT PART OF THE CRITERIA FOR E&M CODES.

Now, for an elementary physics question that applies here: What is mass/volume?

[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.

[biker1]

A code of 99214 was associated with the term "Doctor's office visit, long" on my Supplemental Plan EOB. Some additional clarity such as the time range (that you listed) would be useful if the Supplemental Plan feels the need to provide a description (layman's translation of the code??) of the service. It is what it is.

Originally Posted by Aces4

Yes, it is. Established Patient Codes (Example) 99212: Typically 10-19 minutes 99213: Typically 20-29 minutes 99214: Typically 30-39 minute 99215: Typically 40-54 minutes. I allow for extra time for note taking, updating information and record research and there is no way my visit was a long one. I don't say all Drs. do this but I do think there is bill padding happening in some areas whether directly from the Drs. office or agency coding.

[golfing eagles]

Originally Posted by biker1

A code of 99214 was associated with the term "Doctor's office visit, long" on my Supplemental Plan EOB. Some additional clarity such as the time range (that you listed) would be useful if the Supplemental Plan feels the need to provide a description (translation of the code) of the service. It is what it is.

I believe I gave way more than additional clarity. Not you, but some people want to muddy the waters.

[Aces4]

Originally Posted by biker1

A code of 99214 was associated with the term "Doctor's office visit, long" on my Supplemental Plan EOB. Some additional clarity such as the time range (that you listed) would be useful if the Supplemental Plan feels the need to provide a description of the service. It is what it is.

Your visit was based on the time the physician had to spend for your case and, apparently, your visit took up 30-39 minutes of his time in one way or another. The fact that some people provide clarity of the billing for Medicare makes some prefer muddy water. I am not one.

[biker1]

When people ask me for clarity/explanation, I preface my response with "remember, you asked". Rarely am I asked twice for an explanation by the same person ;-)

Originally Posted by golfing eagles

I believe I gave way more than additional clarity. Not you, but some people want to muddy the waters.

[golfing eagles]

Originally Posted by Aces4

Your visit was based on the time the physician had to spend for your case and, apparently, your visit took up 30-39 minutes of his time in one way or another. The fact that some people provide clarity of the billing for Medicare makes some prefer muddy water. I am not one.

Batting 100% I see. Once again WRONG.

The code 99214 was submitted because it met the following criteria:

Care Components
When it comes to accurate medical billing and coding for a 99214 visit, healthcare providers need to understand the care components involved. This particular visit requires a detailed history, a detailed examination, and medical decision making of moderate complexity. Let’s take a closer look at each component:

Detailed History
The detailed history component of a 99214 visit involves gathering relevant information from the patient. This includes their chief complaint, present illness, past medical history, family history, social history, and a review of systems. It is crucial for healthcare providers to document this information accurately to support the billing and coding process.

Detailed Examination
The detailed examination component involves conducting a thorough physical examination of the patient. This includes evaluating all relevant body systems and documenting any pertinent findings. Healthcare providers should carefully document their findings to ensure accurate billing and coding for the 99214 visit.

Medical Decision Making of Moderate Complexity
The medical decision making component evaluates the complexity of the healthcare provider’s decision-making process for the patient’s care. This includes assessing the patient’s diagnosis, treatment options, and the associated risks and benefits. Healthcare providers should document their medical decision making thought process to support accurate billing and coding for the 99214 visit.

Proper medical billing and coding is essential to optimize reimbursement for healthcare services. By accurately documenting each care component of the 99214 visit, healthcare providers can ensure accurate coding and billing that reflects the level of care provided.

The 2021 revisions to CPT allowed an ALTERNATIVE to meeting those documentation criteria for visits that don't lend themselves to such documentation---notably psychiatry, but something like a family conference about a patient would qualify as well. In that case there are time guidelines, but these are not used often except in psychiatry (which I'm beginning to think might be in play here) and occasionally when an oncologist has a family meeting. The 99214 WAS NOT BILLED for time. IT DOESN"T MEAN LONG!!!!

If unable to answer what mass/volume is, perhaps this would be a better question: Why do some people insist on arguing with an expert in a field they know nothing about????

[Aces4]

Originally Posted by golfing eagles

Batting 100% I see. Once again WRONG.

The code 99214 was submitted because it met the following criteria:

Care Components
When it comes to accurate medical billing and coding for a 99214 visit, healthcare providers need to understand the care components involved. This particular visit requires a detailed history, a detailed examination, and medical decision making of moderate complexity. Let’s take a closer look at each component:

Detailed History
The detailed history component of a 99214 visit involves gathering relevant information from the patient. This includes their chief complaint, present illness, past medical history, family history, social history, and a review of systems. It is crucial for healthcare providers to document this information accurately to support the billing and coding process.

Detailed Examination
The detailed examination component involves conducting a thorough physical examination of the patient. This includes evaluating all relevant body systems and documenting any pertinent findings. Healthcare providers should carefully document their findings to ensure accurate billing and coding for the 99214 visit.

Medical Decision Making of Moderate Complexity
The medical decision making component evaluates the complexity of the healthcare provider’s decision-making process for the patient’s care. This includes assessing the patient’s diagnosis, treatment options, and the associated risks and benefits. Healthcare providers should document their medical decision making thought process to support accurate billing and coding for the 99214 visit.

Proper medical billing and coding is essential to optimize reimbursement for healthcare services. By accurately documenting each care component of the 99214 visit, healthcare providers can ensure accurate coding and billing that reflects the level of care provided.

The 2021 revisions to CPT allowed an ALTERNATIVE to meeting those documentation criteria for visits that don't lend themselves to such documentation---notably psychiatry, but something like a family conference about a patient would qualify as well. In that case there are time guidelines, but these are not used often except in psychiatry (which I'm beginning to think might be in play here) and occasionally when an oncologist has a family meeting. The 99214 WAS NOT BILLED for time. IT DOESN"T MEAN LONG!!!!

If unable to answer what mass/volume is, perhaps this would be a better question: Why do some people insist on arguing with an expert in a field they know nothing about????

I think it takes a lot of audacity to insist another Dr. knows how a visit which I made to my Dr. should be billed. If that Dr. was not in the office with me, didn't see the EOB from that visit and has absolutely no belief in Medicare statements or AIs explanation, then no input is needed as to what I was billed and how the appointment was coded for a long visit. Perhaps a call to Medicare should be next for a former practicing physician for clarity and why they would insist on putting "Office visit, Long" on THEIR form. Take it up with Medicare, I've only provided facts.

[Rainger99]

Originally Posted by golfing eagles

I don't get it. I posted the criteria for just one E&M code, the highest level 99215. I can post others if anyone wants. I threw down the challenge to show me the word "long" anywhere in the requirements. Guess what? IT ISN'T THERE. If someone has seen the word long on their EOB, they are either hallucinating, or it is some sort of attempt to explain the code to an amateur, but it IS NOT AN OFFICIAL TERM. This is the third time I've had to reiterate this, it's really not that hard.

Now we have a new accusation----"some Drs. or their offices do bill this for charge when it has not occurred in any form." If true, and I very much doubt that it is, that would be an example of outright fraud. So naturally the person who posted that has irrefutable proof of their accusation? Of course they do,

It is true that the word long is not there. But 99215 does say 40-54 minutes while other codes are 15-29 minutes or 30-44 minutes or 45-59 minutes or 60-74 minutes. So there appears to be a time element involved.

https://www.ohfama.org/aws/OHFAMA/as...e/904100?ver=1

[collie1228]

If nothing else, this forum has reaffirmed my opinion that the government should not be in charge of health care for anyone. The complexity is amazing. I really like my Medicare Advantage program, but from almost everything I’ve read, the Advantage programs are ripping off the taxpayers. Is that true? Who knows.

[golfing eagles]

Originally Posted by Aces4

I think it takes a lot of audacity to insist another Dr. knows how a visit which I made to my Dr. should be billed. If that Dr. was not in the office with me, didn't see the EOB from that visit and has absolutely no belief in Medicare statements or AIs explanation, then no input is needed as to what I was billed and how the appointment was coded for a long visit. Perhaps a call to Medicare should be next for a former practicing physician for clarity and why they would insist on putting "Office visit, Long" on THEIR form. Take it up with Medicare, I've only provided facts.

Wrong again. Every doctor should know how to bill a visit. And for the last time, TIME HAS NOTHING TO DO WITH IT. If you are so sure you were somehow cheated, maybe you should call the Medicare fraud number at the bottom of your EOB

[golfing eagles]

Originally Posted by Rainger99

It is true that the word long is not there. But 99215 does say 40-54 minutes while other codes are 15-29 minutes or 30-44 minutes or 45-59 minutes or 60-74 minutes. So there appears to be a time element involved.

https://www.ohfama.org/aws/OHFAMA/as...e/904100?ver=1

Only for visits that don’t lend themselves to the usual documentation is impractical. You spend 50 minutes with a psychiatrist, how would you feel if he tried to do a 12 point physical examination? That’s where the ALTERNATIVE time related billing is permitted.