G2212

G2212 | Prolonged Services | Description & Billing Guidelines

G2212 is an HCPCS procedure code used for prolonged services. The physician, or even another skilled and experienced medical specialist, invests an additional 15 minutes, with or without proper consultation, based on the total number of minutes spent on the date of the primary service.

This prolonged service can be used for outpatients. Do not report CPT 99415 or CPT 99416 on the same date as either the CPT 99354, CPT 99355, or the G2212.

G2212, according to CMS, can not be used for specific prolonged medical services. This code can be reported for many medical services like cardiology, CT chest, neurological treatment, etc. We can not report G2212 if the service is less than fifteen minutes. 

Medicare has declared CPT code 99417 invalid, and a new code, G2212, has been established in its place. G2212 can be used for: 

  • Reviewing the maximum time allowed for office visits or other outpatient evaluation and management services (s).
  • Every additional 15 minutes made necessary by the attending physician or any other qualified physician.

Remember that G2212 should never be billed on the same date as CPT 99354, CPT 99355, CPT 99358, CPT 99359, CPT 99415, or CPT 99416. In addition, a patient can never submit code G2212 for a time unit of fewer than 15 minutes. 

CMS’s plans to clarify the possible credit for extended office/outpatient E/M visits are getting very close to being finished as we work to resolve this confusion.

G2212 Description

A physician can report prolonged office/outpatient E/M services using the CPT add-on code G2212 (Prolonged office/outpatient E/M services).

The G2212 HCPCS code is officially described as: “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact.

It considers that after the physician selects a visit level that corresponds to the length of the visit. Therefore, the most up-to-date code for long-term outpatient evaluation and management services is G2212.

In addition to CPT 99205 and CPT 99215, using G2212 to report patients covered by CMS is permissible.

The reporting process requires one G2212 unit in addition to an additional fifteen minutes.

If the separate time of the provider was less than 15 minutes, there is no need to submit Form G2212 because it is not required. If the physician continues to see the patient for an additional half an hour, you should report two G2212 units.

The reporting process requires one G2212 unit in addition to an additional fifteen minutes. G2212 shouldn’t generate a report if the provider spends no more than an additional 15 minutes on the task.

If the provider continues to see the patient for another half an hour, you must report two G2212 sections.

Only one unit of the G2212 item should be entered even if the doctor sees the patient for an additional 19 minutes (or any value less than double, triple, etc.). As an illustration, two units of G2212 would add for every thirty-five minutes spent with a patient.

Billing Guidelines

Each additional 1-14 minutes of protracted service is represented by G2212 when billing the most extensive office visit based on time (CPT 99205 or CPT 99215).

For example, G2212 would give to a new patient after 89 minutes and to an existing patient after 69 minutes.

Here are some examples of how many units you could bill a Medicare provider for regular patient visits lasting more than 54 minutes:

CPT 99215, G2212 from 89 to 103 minutes; CPT 99215, G2212 multiplied by two from 104 to 118 minutes; 99215, G2212 multiplied by three from 119 to 23 minutes.

You must keep track of two billing cycles for the 99417 code: one for Medicare patients and another for those with private insurance.

Understanding how significant payers expect you to account for time spent when billing for extended services is critical.

Each additional 15 minutes of a doctor or other qualified healthcare professional time spent on office or further outpatient evaluation and management services, with or without direct patient contact, pays approximately.

The Centers for Medicare and Medicaid Services and the Current Procedural Terminology agree that direct patient contact and other activities could include calculating the total time spent.

Face-to-face time should consist of all time spent with the patient on the same day as the patient’s visit. If your company requires the provider’s services outside of scheduled meetings, you should consider their availability during those times.

Examples of G2212 include, but are not limited to:

  • checking in with the patient’s medical staff;
  • reviewing charts and records;
  • ordering procedures;
  • medications; and
  • tests.

Direct patient contact excludes time spent with office staff or alone in the office. The office staff consists of all employees who are not the primary service provider.

Additionally, it is impossible to quantify the amount of time a patient spends alone with their primary caregiver.

G2212 is correctly used in the following cases.

  • The amount of time spent on therapy or other separately priced services.
  • A new patient’s initial E/M visit of up to 74 minutes (CPT 99215), 
  • For an established client’s initial E/M visit of up to 54 minutes (CPT 99210).
  • A discussion involves a test report, a medical treatment, and a visit. 
  •  The length of time the patient is in the office with a caregiver and how long they are alone.
  • Inappropriate clinical service use results in unnecessary, lengthy face-to-face contact time.

How To Use Modifier 25 With G2212

G2212 can be reported with Modifier 25 if supporting documentation elucidates the nature of the service provided and demonstrates that it is significant and easily distinguishable from other services or procedures performed on the same service date. 

G2212 has a three-unit limit, and any requests for more must accompany a medical justification denied. When selecting a visit level based on time, the practitioner can report prolonged office visit time using the CPT supplementary code G2212. 

The medical record should detail the duration, specifics, and costs of the comprehensive services that were billed, in addition to the medical services that could determine to be necessary.

The patient’s medical record must contain appropriate documentation to prove that a doctor or qualified non-physician practitioner (NPP) personally supplied the direct face-to-face interaction with the patient that the CPT code definitions will require,

Modifier 25 can reimburse the medical payment of the prolonged services involved in the G2212 code; this service does not depend upon the time included in the extended service provision.

Gynae and delivery service will not fit in the G2212. In the case of the proper reimbursement process, the appropriate documentation and detail of the patient history will also need for the prolonged service billing process in the case of the G2212 code.

Reimbursement

When billing performs the most extensive office visit based on time, G2212 accounts for every additional 1-14 minutes of service time beyond CPT 99205 or CPT 99215, G2212 will reimburse 89 minutes for a new patient and 69 minutes for an existing patient.

Long-term labor and delivery services will not consider precisely defined benefits and thus are not reimbursable. 

According to CMS regulations, if EH Medicaid does not cover G2212, use CPT 99417 instead. Prolonged services during labor and delivery are not considered separate services and are not reimbursable.

Example

A patient with an infection in the chest comes to the physician; the total E/M service time for a patient with a known history and high risk was 83 minutes. The contact of the patient with the physician is face-to-face.

After an electrocardiogram (EKG) and chest x-ray revealed pneumonia, the healthcare provider documented the patient’s critical condition and hospitalization decision.

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