Wiki add on codes 99354-99357

[lrwinther]

If I have an office visit that meets the criteria for a 99212 but the time the physician spent with the patient was over one hour - what is the proper coding? Should the office visit code increase to 99214 and be billed with the add on code or should it stay as 99212 with the add on code. Thanks for your help!!

 

[noell426]

Prolonged Visits

Keep the visit level as is, as long as it is accurate. Prolonged visits are billable strictly based on time, not E & M level. In your particular case, I would just add a "99354" with the E&M code. This code is warranted when the physician spends >30 min face to face with the patient, up to the first hour. After that, you can add 99355 x's each subsequent 30 min. We use the prolonged codes more frequently than most since my doc spends extended amounts of time with her patients and it is the only way she will be compensated for her time. As we all know there are many patients out there that take up more than the usual time needed to discuss minor concerns or conditions - especially the elderly. Make sure the amount of time that the physician spent face to face with the patient is well documented and you will be covered.