tci E/M Coding Alert - 2021 Issue Q4

Reader Questions: Don’t Use Prolonged Service for Extra E/M Time

Question: Our provider performed an office evaluation and management (E/M) service for a new patient. It was an extensive encounter; there was high-complexity medical decision making (MDM) and the visit lasted 84 minutes. Can I use the new prolonged service code to account for the extra E/M time? New Mexico Subscriber Answer: In this case, no. You should report 99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total...

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