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Radiology Coding Alert

Reader Question:

Prolonged Service Codes

Published on Wed Aug 01, 2001

Question: Is it acceptable to bill CPT 99354 and CPT 99355 with any radiology procedures?

California Subscriber
 
Answer: Per CPT, the codes you cite describe prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service ... Code 99354 is an add-on code for the first hour spent beyond usual service, and 99355 is an add-on for each 30 minutes beyond that.
 
These add-on codes are usually billed in addition to E/M visit codes and would almost never be reported with radiology or procedural services. Codes 99354 and 99355 are time-based codes that would be paired with base service codes that also have time frames assigned, e.g., each E/M code has an average time assigned to it. However, this scenario would not apply to radiology practices because no radiology procedures now have typical duration times attached to them.
 
Another key that your physician should be aware of is the use of beyond the usual service in the code definitions. This could not be used for radiology procedures such as arthrograms unless something went drastically wrong and the physician had to stay with the patient for another 30 minutes or more. The doctor cant include the time normally spent doing the procedure. If the prolonged service occurs in the recovery room, the physician has to be present. Prolonged service codes dont require the time spent with the patient to be continuous, but it must be face-to-face.

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