Radiology Coding Alert

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

Pennsylvania Subscriber

Answer: Per CPT Codes , 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 codes, and would usually not be reported with radiology or procedural services with the exception of some interventional radiology procedures. Codes 99354 and 99355 are time-based and would be paired with base service codes that also have associated time frames as part of their descriptors (e.g., each E/M code includes an average time). However, these add-on codes do apply to many radiology procedures because there are no time increments currently attached to them. Other language that your physician should be aware of is the use of beyond the usual service in the code definitions. The physician cant include the time normally spent doing the procedure.

When complicated procedures like endovascular graft placements are performed, interventional radiologists may provide E/M services that exceed the usual duration of an E/M code. In these cases, the radiologist may assign prolonged service codes. In short, the rules for the use of these E/M codes apply to radiologists no differently than any other physicians.

You Be the Coder and Reader Questions were answered by Donna Richmond, CPC, a radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., which serves more than 200 radiologists, pathologists and anesthesiologists.