New E/M add on code of 99417 issues.

Kim N 3 years ago in Industry News/Discussion updated by Shauna Dall 3 years ago 1

Wondering if anyone has had a similar experience with billing the new 99417 code to MN MA DHS?  It is being denied by MN MA DHS. We have called on the denial and  the call center states it can't be added to 99205 or 99215.  Which doesn't make sense as it was developed to only be added to those codes.  It is paying fine for other Payers....   Thoughts?

Would you use the 99417 as a single code inclusive of all of the 15 min increments?

I found this in an article . . .  

2. Prolonged services coding will also change. The multiple current codes will become a single CPT code, 99417, which you can bill in 15-minute increments when total time exceeds a level 5 visit. So, a visit of 55-69 minutes with an established patient would require 99215 plus a single 99417 prolonged services code. A visit of 70-84 minutes with an established patient would take a 99215 plus two 99417 prolonged services codes, and so on. CMS, however, has decided to allow physicians and other qualified health care professional to bill for prolonged services only when they have exceeded the maximum time for a Level 5 visit by 15 minutes or more (at least 69 minutes for an established patient and 89 minutes for a new patient), rather than the minimum time. Because of the discrepancy, Medicare has its own code, G2212, for reporting prolonged services.