Wiki Help with Prolonged Service with E&M Pls!

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My physician spent 60 minutes face to face with mom + pediatric pt, documenting time and "greater than 50% of visit spent counseling" in the note. Based on History, Exam and MDM, it's a solid 99214. Is there a code for "prolonged services" that would compensate my provider for the 35 minutes spent in addition to the 25 min of the 99214? Only one I found(99354) is for AFTER 1 hour is spent. Can I bill a 99215 based on time alone (40 minute visit, closer to the 60 spent) or do I have to bill the 99214 and eat the remainder of time spent? Thanks!
 
99354 is for a minimum of 30 minutes after the visit level is deducted. Look in the CPT book at the table following 99354.
So yes bill the 99214 and the 99354 just be sure you have medical necessity to justify.
 
Debra, THANK YOU for your reply. I did bill 99214, with 99354 originally. I can totally justify medical nec, it's a very complicated case. The mom disagrees with our code usage. I did re-review the written guidelines before the code listing in my CPT, and I started second guessing myself. It states "code 99354 is used to report the first HOUR of prolonged service on a given date, depending on pos". Then the actual code listing says "requiring direct patient contact beyond the usual service; first HOUR. I just want to make sure that I don't have to spend ANOTHER Hour with the patient after the first hour to qualify for 99354. Thank you, truly for taking the time to help me!
 
no if you look at the table it will be more clear. A timed service requires 50% of the required time before it can be billed, in some cases it is 1 minute over 50% but in this case it is 50%, then to bill the next level you have to be 15 minutes over the first hour (since the next level is a 30 minute service), that should help explain the table break down.
30 -74 over the visit time is the 99354 (30 minimum thru the 60 then 15 over to get to the next level) so
75-104 is the 99354 plus the 99355 and so on.
 
Debra,

Thanks for the clarification, and rebuilding of my coding confidence, I did do it right the first time! :) I'm better prepared for the challenge with mom now- THANK YOU!
 
Skilled nursing facillity

Hi,

In SNF(skilled nursing facillity) based on report i found 99306(HPI,PE,MDM) and provider should mention in end of report that Spent 30 minutes reviewing patient's discharge documentation from Hospital.So,can we billed prolonged service based on this documentation and if we billed then how?

Please help!
 
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