Cardiology Coding Alert

Question: The cardiologist spent 105 minutes evaluating a new patient in the office. Is 99205 the only code I can bill?

Massachusetts Subscriber

Answer: You also should look at the prolonged office visit codes +99354-+99355 (Prolonged physician service ... requiring direct [face-to-face] patient contact ... ).

Here's why: Code 99205 (Office or other outpatient visit for the evaluation and management of a new patient ... Physicians typically spend 60 minutes face-to-face with the patient and/or family) notes the service typically involves 60 minutes of faceto-face time. But if your cardiologist spent 105 minutes with the patient, then you can bill 99205 for the first 60 minutes plus +99354 to capture payment for the extra time.

Important: There is a 30-minute threshold time with the prolonged services codes before those codes kick in. In other words, count 30 minutes more beyond the usual time for the reported E/M service before using the prolonged services codes.

In the case you describe, you should report 99205 for the first 60 minutes, take into account 30 minutes threshold time, and then add +99354 for the additional 15 minutes to reach 105 minutes.

Remember that codes +99354-+99355 are time-based and are add-on codes. You do not need to append a modifier to these codes, and you should not decrease their reimbursement when billed with other primary E/M codes. Also note that you should use +99354-+99355 only once per date, even if the time spent by the physician is not continuous on that date.