Mr. Flintstone is seen after Hodgkin's lymphoma work-up; time totals 11 minutes for exam and 45 minutes for discussion, plus 15 minutes CPR. What CPT coding is reported?

Mr. Flintstone is seen after Hodgkin's lymphoma work-up; time totals 11 minutes for exam and 45 minutes for discussion, plus 15 minutes CPR. What CPT coding is reported?

• A. 99215, 99417
• B. 99213
• C. 99205
• D. 99205, 99417

Answer: (A)

The key idea is using time to choose an E/M code and then applying a prolonged-service add-on when the encounter time goes beyond the usual. For an established patient, a lengthy office visit with substantial counseling fits 99215. The typical time for this level is around 40 minutes, but this encounter totaled 11 minutes for the exam plus 45 minutes of discussion (counseling/coordination) plus 15 minutes of CPR, for a total of 71 minutes. Because the total time exceeds the usual by more than 60 minutes, you add the prolonged-service code 99417 to capture the first hour of that excess time. The remaining minutes aren’t enough to bill another prolonged increment. So, the best coding is an established-patient office visit at the high level (99215) plus a prolonged-service add-on (99417) for the first hour of extra time. The CPR time is counted within the total encounter time and isn’t billed separately.

The key idea is using time to choose an E/M code and then applying a prolonged-service add-on when the encounter time goes beyond the usual. For an established patient, a lengthy office visit with substantial counseling fits 99215. The typical time for this level is around 40 minutes, but this encounter totaled 11 minutes for the exam plus 45 minutes of discussion (counseling/coordination) plus 15 minutes of CPR, for a total of 71 minutes. Because the total time exceeds the usual by more than 60 minutes, you add the prolonged-service code 99417 to capture the first hour of that excess time. The remaining minutes aren’t enough to bill another prolonged increment.

So, the best coding is an established-patient office visit at the high level (99215) plus a prolonged-service add-on (99417) for the first hour of extra time. The CPR time is counted within the total encounter time and isn’t billed separately.