Wiki 99386 billed with 99354

[adecker]

Hi, Can anyone assist me in getting some information on this scenario. I work for a local insurance company in upstate NY. A provider is billing

99386-preventive
99354-prolonged

total of 90 minutes face to face

I needed to know if there is any documentation out there that can show why preventive visits cannot be billed with a prolonged service since the preventive visit is an E/M code? Is it because the preventive vists are age specific? Thanks

99381-99397 Preventive Medicine Visits - (99381-99397)
99354-99357 Prolonged Services Direct Contact - (99354-99357)

CPT code manual states
"(use 99354 in conjunction with 99201-99215-, 99241-99245, 99324-99337, 99341-99350, 90809, 90815")

 

[LOVE2CODE]

Hi, Can anyone assist me in getting some information on this scenario. I work for a local insurance company in upstate NY. A provider is billing

99386-preventive
99354-prolonged

total of 90 minutes face to face

I needed to know if there is any documentation out there that can show why preventive visits cannot be billed with a prolonged service since the preventive visit is an E/M code? Is it because the preventive vists are age specific? Thanks

99381-99397 Preventive Medicine Visits - (99381-99397)
99354-99357 Prolonged Services Direct Contact - (99354-99357)

CPT code manual states
"(use 99354 in conjunction with 99201-99215-, 99241-99245, 99324-99337, 99341-99350, 90809, 90815")

OK--They should have billed it as a preventive code then a counselling code (99401 - 99403) instead....Lots of offices don't utilize those counselling code but it is better. Hope this helps..

 

[mitchellde]

You canot append the prolonged codes to the preventive codes as it is not allowed by CPT conventions and the preventive visit levels have no timed component for the visit itself.