Wiki Home Visit (99345) and Prolonged (99354)

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mandyr3376

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I started billing for a physician that only does home visits. When we bill for the e/m part 99345 do we have to do anything special to the claim to get paid for the prolonged service 99354 that was also performed. Thank you in advance for any insight on this matter.
:confused:
 
Home visits

what type of visit are they ? I bill for home health we bill most of the visit with a 99347 . Normally there is nothing special to add . We bill exactly was the authorization states . If we bill anything else it kicks out .
 
99345 is the e/m code for a home visit new patient...and of course the 99354 is the prolonged visit code
 
the only thing special you need for the prolonged codes is the medical necessity to support the code. Look under the 99354 code to be sure the 99345 is listed as a valid code for the 99354 to be added on to. There must be total face to face time documented and 30 minutes more than the visit level time to qualify.
 
This was most helpful. I want to make sure there is no modifier that I have to add because I recall when doing E/M billing for a family practice I would bill MC for the 99214 and then add teh 99354 and we would get reimbursed for the 99214 but not the prolonged. Idea on what we should have done with that since it is allowed according to CPT?
 
it should be appealed if it was in fact coded correctly. The payers use the dx code(s) to justify the prolonged codes, if you use unspecified then generally the prolonged will be denied.
 
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