APMA News - September/October 2021 - 31

Coding
Table 23
. Use of Code 99417 with Code 99215*
Total Duration of
Established Patient Office
or Other Outpatient
Services (use with 99215)
Less than 55 minutes
55-69 minutes
70-84 minutes
85 minutes or more
Codes
Not reported separately
99215 X 1 and 99417 X 1
99215 X 1 and 99417 X 2
99215 X 1 and 99417 X 3
or more for each additional
15 minutes
*Code 99215, Office or other outpatient visit for the evaluation and
management of an established patient, requires a medically appropriate history
and/or examination and high level of medical decision making. When using time
for code selection, 40-54 minutes of total time is spent on the date of the encounter.
Reporting Prolonged Services for Office or Other
Outpatient E/M Services to CMS and UHC
HCPCS Code G2212-Prolonged office or other outpatient
evaluation and management service(s) beyond the maximum
[emphasis added] 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
health-care 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).
The difference between CPT 99417 and HCPCS G2212 is
that CPT 99417 accounts for time beyond the minimum required
time of the primary procedure, while HCPCS G2212
accounts for time beyond the maximum required time of the
primary procedure.
Podiatric Examples
Example #1
Provider spends a total of 90 minutes combined face-to-face
and non-face-to-face time providing an E/M for a new diabetic
patient with angiopathy requiring immediate vascular
work-up and who has a diabetic foot ulcer, cellulitis, and septicemia.
The CPT code level is selected based on total time,
which included creating a lengthy progress note, calling the
emergency department, and making referrals to infectious
disease and vascular colleagues.
Medicare/UHC Patient: One unit of CPT 99205 and
one unit of HCPCS G2212.
CPT 99205 accounts for the first 74 minutes and Medicare
and UHC state HCPCS G2212 may not be used until 15 minutes
beyond the maximum required time of the primary procedure
has been spent. Therefore, no extra code is considered
until 15 minutes beyond the maximum time-74 minutes in
this case-have been spent. No extra code can be considered
until 89 minutes have been spent. Because 90 minutes were
spent on this encounter, one unit of G2212 is added.
Non-Medicare and Non-UHC Patient: One unit of
CPT 99205 and two units of G2212.
The minimum required time of the primary procedure, 60
minutes in this scenario, has been exceeded by two increments
of 15 minutes.
Example #2
The same scenario in Example #1 takes place for an established
patient. Ninety minutes of total time are spent, and the
code level is selected based on total time.
Medicare/UHC Patient: One unit of CPT 99215 and
two units of G2212.
CPT 99215 accounts for the first 54 minutes and Medicare
and UHC state HCPCS G2212 may not be used until 15 minutes
beyond the maximum required time of the primary procedure
has been spent. Therefore, no extra code is considered
until 15 minutes beyond the maximum time, 54 minutes in
this case, have been spent. No extra code can be considered
until 69 minutes have been spent. Because 90 minutes were
spent on this encounter, two increments of 15 minutes beyond
the maximum time, two units of G2212 are added.
Commercial Patient: One unit of CPT 99215 and
three units of G2212.
The minimum required time of the primary procedure, 40
minutes in this scenario, has been exceeded by three increments
of 15 minutes.
Have questions about coding? Email coding.hpp@apma.org. n
1
Current Procedural Terminology (CPT®) is copyright 1966, 1970,
1973, 1977, 1981, 1983-2020 by the American Medical Association. All
rights reserved. CPT is a registered trademark of the American Medical
Association (AMA).
2
CPT Assistant Online https://ocm.ama-assn.org/OCM/CPTAA/Overview.do
3 2021 CPT Professional - Current Procedural Terminology (CPT®
) is copyright
1966, 1970, 1973, 1977, 1981, 1983-2020 by the American Medical
Association. All rights reserved. CPT is a registered trademark of the American
Medical Association (AMA).
APMA News September/October 2021 31

https://ocm.ama-assn.org/OCM/CPTAA/99417 https://ocm.ama-assn.org/OCM/CPTAA/99215 https://ocm.ama-assn.org/OCM/CPTAA/99215 https://ocm.ama-assn.org/OCM/CPTAA/99215 https://ocm.ama-assn.org/OCM/CPTAA/99417 https://ocm.ama-assn.org/OCM/CPTAA/99215 https://ocm.ama-assn.org/OCM/CPTAA/99417 https://ocm.ama-assn.org/OCM/CPTAA/99215 https://ocm.ama-assn.org/OCM/CPTAA/99417 https://ocm.ama-assn.org/OCM/CPTAA/99215 https://ocm.ama-assn.org/OCM/CPTAA/Overview.do

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