Reader Question: Use 25 with New Prolonged Services Codes to Max Out Payment

Article Overview

This article addresses a coding question involving a new patient office visit, a colonoscopy, and additional counseling time provided by a non-physician in a gastroenterology setting. It discusses how the encounter is framed for reporting purposes, highlights the related CPT code set and modifier use, and notes uncertainty about payer payment for the newer prolonged service codes. The piece is aimed at coders and billing staff who need to evaluate whether the scenario fits current CPT guidance and payer policy.