BC Advantage - 2023 Issue 1

A Long Time Coming: 2023 Changes to Inpatient Prolonged Service

It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged service codes in the office/outpatient setting. This process culminated in a disagreement between the AMA's CPT manual and CMS's fee schedule final rule, with CPT using add-on code +99417 for office/outpatient prolonged services versus CMS creating its own code, +G2212. The CMS code also operates on a slightly different time scale than +99417, leaving coders and auditors with the dreaded "one rule for CPT, a different rule for Medicare" dynamic that can only complicate and prolong...

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