Internal Medicine Coding Alert

When patients require longer-than-normal physician visits, you can use prolonged services codes 99354-99357 with the home visit codes.

Some physicians believe they must use the highest-level E/M code in a category to add on the prolonged services codes, but this is not true, says Karen Jeghers, PA-C, CPC, president of Compliant Billing Services in Carver, Mass.

For example, a physician sees a patient at home and documents medical complexity to support billing 99348 but spends a total of 55 minutes face-to-face with the patient, who is a paraplegic, and his family discussing social issues related to the paraplegia. The physician can also bill prolonged services code 99354 (30-74 minutes).

"Document the amount of time that the physician spent face-to-face with the patient or the patient's family, not the amount of time spent in the home," Jeghers says.