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Dermatology Coding Alert

READER QUESTIONS:

Look to Your Op Note When Reporting 99354

Published on Mon Apr 11, 2005

Question: A patient comes for a routine skin exam. During the exam, the patient tells the dermatologist that a specific mole has been itching and bleeding. The dermatologist spends more time with the patient than a level-two E/M service typically takes (about 10 minutes). What should our claim look like?


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Answer: In this case, you should report a prolonged service code with the E/M code on this claim. The claim should read:
 

  • 99212 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making
     
  • +99354 - Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (list separately in addition to code for office or other outpatient evaluation and management service). 

    Tip: Use 99354 for the first 30-74 minutes of outpatient prolonged service time and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) for each additional half-hour for outpatients beyond 74 minutes.

    Remember: To use the first-hour prolonged service codes, the dermatologist must provide at least 30 minutes of prolonged service beyond the CPT-allotted time for that E/M service, coding experts say.

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