Medicare created a new HCPCS Level II code for use in place of CPT code +99417 when billing Medicare for prolonged office/outpatient E/M services: The main difference between the two codes is that +99417 applies to prolonged services 15 minutes beyond the minimum required time and +G2212 applies to prolonged services 15 minutes beyond the maximum required time. The AMA CPT Editorial Panel annually screens the codeset for codes that are rarely or never used. All rights reserved. In addition, code 0581T may be reported only once per breast treated no matter how many tumors are ablated, whereas code 19105 should be reported for each fibroadenoma ablated. 
The table also includes the 2021 RVUs for new prolonged services code +G2212. Note that code 0581T includes any imaging modality for guidance, whereas code 19105 only includes ultrasound guidance. MPFS facility RVUs are often lower than non-facility (office) RVUs because when a physician provides services in a facility, the physician is responsible for fewer practice expenses. You should not assign another unit of +99417 until the encounter reaches 90 minutes, which is 15 minutes more than 75 minutes. The new code includes total time with and without direct patient contact on the date of service. Upon review, the stakeholder specialties determined that code 19304, Mastectomy, subcutaneous, has been misreported for a mastectomy procedure that included a nipple- or skin-sparing technique, which should have correctly been reported as a mastectomy procedure using code 19303, Mastectomy, simple, complete. OR has a good prognosis with management/compliance, patient history, clinical examination, and medical decision making (MDM), 2021 office and outpatient E/M guidelines and code descriptors, Level of Medical Decision Making (MDM) table, Take the Complexity Out of Behavioral Health Coding, Coder review 99212/Provider insist on 99213, Tech & Innovation in Healthcare eNewsletter, Medically appropriate history and/or examination, Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services), 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 (list separately in addition to cpt codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). The 2021 MPFS final rule changed the descriptor slightly and confirmed the code would be part of the 2021 HCPCS Level II code set: The MPFS 2021 final rule indicated Medicare would reimburse providers for this code, but December 2020 legislation related to COVID-19 relief changed this by including a moratorium on payment for G2211 until at least January 2024. Refer to the CPT code book for detailed guidelines and coding instructions. Cryoablation of malignant breast tumor(s) will now be reported with a new code, 0581T, Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral. Codes 35721 (exploration of femoral artery) and 35741 (exploration of popliteal artery) were deleted with directions to report exploration of a lower extremity artery with code 35703. Physicians receive up to 6.5 AMA PRA Category 1 Credits for each day of participation. The 2020 MDM guidelines included comparable wording, but they did not include the reference to shared MDM or the examples found in the 2021 guidelines. The 2021 Time guidelines explain that for 99202-99205 and 99212-99215, total time on the encounter date includes both face-to-face and non-face-to-face time spent by the provider. You now have the opportunity to claim CME credit for time spent reading the monthly Bulletin of the American College of Surgeons. The patient must be an established patient, although the problem may be new. In 2017, the CPT Assistant Editorial Board requested clarification for coding nipple- and skin-sparing mastectomy procedures. CPT Category III code eligibility for payment, as well as coverage policy, is determined by each individual third-party payor. CPT Category III codes do not have assigned RVUs and are considered emerging or evolving procedures or services. Chicago, IL 60611, Revision of guidelines for repair (closure), Transanal hemorrhoidal dearterialization (THD), Radiofrequency spectroscopy at time of mastectomy, Vessel assessment prior to creation of hemodialysis access, Deletion of rarely used or outmoded procedure codes, Nashville, TN, August 68 (third day focuses on trauma), Chicago, IL, November 1214 (third day focuses on trauma). One code (35701) has been revised, two new codes (35702, 35703) have been added, and three codes (35721, 35741, 35761) have been deleted. The MPFS provides this example: 99215 has a time range of 40-54 minutes. In 2020, the guidelines instead referred to the number of possible diagnoses and/or the number of management options.. Integumentary system, other flaps and grafts. In other words, you assign 99205 and +99417 to report 75-89 minutes. Instructions also have been added for correct reporting of bilateral procedures, and new introductory text has been added to the Breast, Mastectomy Procedures subsection that describes and differentiates mastectomy procedures. Table 2 provides the new and revised code descriptors and RVUs for 2020. This codeset includes significant restrictions and instructions for correct reporting. Long-term monitoring occurs at least quarterly. The guidelines preceding the breast biopsy codes (previously under the deleted Excision subheading) have been extensively revised, including the addition of clear instructions for reporting percutaneous and image-guided breast biopsy, open incisional breast biopsy, and open excision of a breast lesion. The descriptors state that you should not use +99354 and +99355 as add-on codes with office/outpatient codes 99202-99205 and 99212-99215. Under CPT rules you start counting based on the minimum time required for the code. The 2019 MPFS final rule included a plan to create two new G codes to represent the visit complexity inherent to certain services, with one code for designated specialists and a second code for primary care providers. The expansion of electronic health record use with associated Health Insurance Portability and Accountability Act (HIPAA)-compliant patient portals has resulted in the creation of three new online digital evaluation and management (E/M) codessometimes referred to as an eVisit. CPT Category III code 0249T, Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance, has been deleted and converted to CPT Category I code 46948, Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed. When artery exploration is performed on the same side of the neck as blood vessel repair; exploration for postoperative hemorrhage, thrombosis, or infection; or flap or graft procedures in the neck, code 35701 may not be reported separately. New code 46948 indicates that at least two columns/groups must be treated to report this code. The stakeholder societies determined that this code represented many different types of tissue grafts that required different physician work. When required, a ring of sutures also will be deployed to pull up a prolapse (mucopexy). CPT Category III code eligibility for payment, as well as coverage policy, is determined by each individual third-party payor. 1. *All specific references to CPT codes and descriptions are 2018 American Medical Association. You will use +99417 once for each 15 minutes beyond the minimum required primary service time. A second code (49014) was approved for packing removal that will occur on a subsequent day. The type of monitoring used should be the generally accepted kind for that agent, although patient-specific monitoring may be appropriate, too. 
The guidelines also clarify that complex repair includes all the requirements listed for intermediate repair plus at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges; extensive undermining; involvement of free margins of the helical rim, vermillion border, or nostril rim; or placement of retention sutures. The Military Health System Strategic Partnership American College of Surgeons (MHSSPACS) was established in 2014 to improve educational opportunities, inform systems-based practices, and drive surgical research capabilities. The AMA RUC identified code G0365 as potentially misvalued because it never was reviewed for physician work and had Medicare utilization greater than 30,000. As a result, pricing of these codes is an important subject, both for providers and for Medicare. The 2020 MDM guidelines also included the amount and/or complexity of medical records, test, and other information involved, but the 2021 guidelines expand the section significantly. The guidelines also will include a definition and an illustration (see Figure 1) of extensive undermining. Code 0377T, Anoscopy with directed submucosal injection of bulking agent for fecal incontinence, also will be deleted because no party expressed an interest in maintaining it. New instructional parentheticals were added to direct reporting code 19300, Mastectomy for gynecomastia, for breast tissue removed for breast reduction for gynecomastia and code 19318, Reduction mammaplasty, for breast tissue removed for breast size reduction for other than gynecomastia. Physicians should continue to report cryoablation of fibroadenomas with code 19105, Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma. These two new codes differ from other exploratory procedures in that a laparotomy is not performed. Call 844-334-2816 to speak with a specialist now. The AMA argued against Medicares reasoning when commenting on MPFS 2021, but Medicare finalized +G2212 and requires that code for Medicare claims. Examples include deciding against hospitalization for a psychiatric patient with sufficient support for outpatient care or choosing palliative care for a patient with advanced dementia and an acute condition. Code 35761 (exploration of other artery) was deleted with directions to use 37799 to report vascular exploration not followed by surgical repair, other than neck artery, upper extremity artery, lower extremity artery, chest, abdomen, or retroperitoneal area. Because the role of time changed for office and other outpatient E/M codes in 2021, the AMA revised the Prolonged Services section of the CPT code set.
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