Podiatry Coding & Billing Alert

Answer: You should opt for prolonged services codes for the visit.First, if your physician spent more than 50 percent of the face-to-face visit time with the patient in counseling or coordination of care, you may report E/M codes 99201-99215. However, remember to attach diligent documentation to bolster your claim.

 

While reporting the encounter, make sure to document all the details regarding:

Typically, your case would be appropriate for 99214 (Office or other outpatient visit for the evaluation and management of an established patient,…) where the physician spends 25 minutes with an established patient and 20 minutes of that time was for counseling.

 

No prolonged E/M service code is reportable if the prolonged service is less than 30 minutes beyond the typical time of the base E/M code. However, your provider spent at least one hour of face-to-face time with the patient beyond the typical E/M visit length and more than 50% of the time was utilized in counseling. You should report this encounter in the outpatient setting with +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour …) as the secondary code. For hospital settings, the code is +99356 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour …). Please remember to use the appropriate primary E/M code before +99354 or +99346 for prolonged services to be payable.

 

You can report only one unit of either +99354 or +99356 per date of service.