# Extended E&M



## dan528i (Sep 22, 2009)

Just wanted to make sure: 99354 is billed in addition to appropriate E&M w/ same DX and NO mod.  RIGHT???


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## DVoyles (Sep 22, 2009)

That is correct


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## jgf-CPC (Sep 22, 2009)

*99354*

CPT's prolonged services codes (99354-99357) should be used only when you've exceeded the time component for the appropriate evaluation and management (E/M) visit. No modifier needed and same Dx is used.


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## RebeccaWoodward* (Sep 22, 2009)

See if this helps... 

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5972.pdf


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## dan528i (Sep 22, 2009)

Thank You ALL !!!!


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## imjsanderson (Sep 22, 2009)

It would have to be above a 99215.  Has anyone ever billed and paid for prolonged services?


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## mitchellde (Sep 22, 2009)

It does not have to be above a 99215, a 99354 can be appended to any visit level, I have coded this way many times and always been reimbursed by every carrier.  The reimbursement is always excellent.


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## RebeccaWoodward* (Sep 23, 2009)

Debra is absolutley correct. CPT clearly indicates that 99354 is used in conjunction with CPT codes 99201 *through* 99215, 99241-99245, 99324-99337, 99341-99350, 90809, 90815 

 99215 would be applicable in this situation...

Question:  I spent 45 minutes face-to-face with a patient counseling them on how to manage their diabetes (in the non-facility setting). History, examination and decision making were consistent with code 99213. The combination of codes 99213 and 99354 pays more than code 99215, can I use the code 99213+99354 combination?

Answer:  No. The dominant service was counseling and time is the correct basis of code selection. Therefore, the highest level of service must first be utilized before using a prolonged services code. Only code 99215 should be reported.

Per CPT Assistant.....

New language was also added to the guidelines to indicate that these add-on time-based codes require that the primary E/M service have a typical or specified time included in their descriptors. However, when counseling and coordination of care are not the dominant service (ie, time is not the basis of E/M code selection), the prolonged service code may still be used.

An example would be a patient who cannot hear, and the extra work of communicating with the patient requires more than 30 minutes beyond the typical time allotted for the E/M service.


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