Pediatric Coding Alert

Question: A patient presents for a scheduled well visit (99391). The patient's medical problems at the time of the well visit prolonged the encounter. Is it appropriate to bill:
 
99391, V20.0 (Health supervision of foundling)
99354, 783.43, 473.0?

Florida Subscriber Answer: No, you may not report a prolonged service code (+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]; or +99355, ... each additional 30 minutes [list separately in addition to code for prolonged physician service]) with a preventive medicine service (99381-99397).

You may only use 99354-99355 as add-on codes to time-based codes. CPT doesn't base preventive medicine codes, such as 99391 (Periodic comprehensive preventive medicine service re-evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, established patient; infant [age under 1 year]), on time. That's why CPT's note following 99354 states, "Use 99354 in conjunction with codes 99201-99215, 99241-99245, 99301-99350."

You should instead report the problem-related portion with the appropriate office visit code (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient). Then, append modifier -25 to 9921x to indicate that the sick visit is a separately identifiable service from the well exam. Link 9921x-25 to 783.43 (Lack of expected normal physiological development in childhood; short stature) and 473.0 (Chronic sinusitis; maxillary).