Review your coding and make sure that you are compensated for all that you do for your Medicare screening procedures and preventative visits!

Are you finding that Medicare-covered preventative visits or Medicare diagnostic screening services are taking much more time than you anticipated?  Here’s a coding tip article to remind you that, with the proper documentation as to the length of face to face time with your patient for some selected services to Medicare patients, you can bill for the additional time used to complete the exam/ screening and increase the revenue into your practice!

The new prolonged service codes (G0513 and G01514), are eligible for you to report as add-on codes to 18 Medicare-covered preventive services as detailed below:

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The add-on codes, and when they can be used are detailed below:

·         G0513 (Prolonged preventive service[s] (Ohio MC reimbursement $64) [beyond the typical service time of the primary procedure] in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes [List separately in addition to code for preventive service]) and

·         G0514 (Prolonged preventive service[s] (Ohio MC reimbursement $64) [beyond the typical service time of the primary procedure]in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes [List separately in addition to code for preventive service]).

Both codes are part of an intentional effort by CMS to create more opportunity for providers that report a heavy dose of E/M services that add value to their practices, states CMS in the final rule.

Note that, in an add-on document to the fee schedule, CMS has allotted times to each of the 18 preventive services to which the new codes can be attached, which means you’ll need to keep a careful track of time that your physicians are engaged with patients during the preventive visit.

For Example: CMS set a threshold of 30 minutes for each AWV Code G0438. That means, according to CPT rules, you’ll have to hit at least 46 minutes – or past halfway of the 30-minute service time of add-on code G0513 – to be eligible to report G0438 plus G0513. Doing so would net you an additional $64 for G0513 on top of the $173 for G0438 – a tidy sum of $239 that many reflect work you’ve already been doing. The new codes may give you extra incentive to bring your patients in the door for covered preventive care.

Note that the time valuation represents some codes, such as the bone-density or mammography screening, that may not be tied to direct physician interaction. “For Medicare-covered preventive services with no face-to-face physician work, the typical time is the service period clinical staff time that best represents the face-to-face time with the patient,” states CMS in the final rule. Just make sure to split the code among services.

“It applies to the clinical staff time, unlike 99354,” said Peter Hollmann, M.D., at the 2018 AMA Symposium in November, referencing the series of face-to-face prolonged service codes (99354-99355) that require physician or non-physician practitioner time. A CMS spokesperson confirmed to Part B News that the new codes are eligible even for services involving solely face-to-face time with clinical staff and not the provider.

That means encounters that go at least 16 minutes beyond the allotted time, even those with face-to-face clinical staff time, are eligible for G0513. Encounters that extend 46 minutes past the valued time would necessitate G0514. Note that when reporting G0513 and G0514, no deductible or copay applies.

If you have any questions on how to correctly use these Add-on codes, please contact Sheryl Houlis, Coding Consultant at Alta Partners, 440-808-3703.

Mike Michelakis