Wiki Prolong Code

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codernickie

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My doctor saw a new patient face to face for 80 minutes. She is basing the E&M code off of time. I know for a new patient 99205 is 60 minutes. Would it be 30 minutes over 60 minutes? Can anyone explain if a prolong code is needed for this visit. I am having a hard understanding when it is appropriate to use the prolong code.

Thanks for your help

Nickie, CPC
 
If you are using prolonged time, you base the visit level on the key components not time. Then you take the total visit time documented and subtract the visit level time per the CPT book. If the time left over is 30 minutes or more then you append prolonged time.
If the entire visit is counseling and you are basing the level on total time then you could only bill a 99205. If there was documentation of the 3 key components and the visit time is 80 minutes the if the visit level meets the criteria for a 99204, that is a 45 minute visit level per the CPT. You subtract 45 from the 80 and get 35. This will be billed as a 99204 plus the 99354. So it just depends on the documentation.
 
Hi Debra,

I am reading the coding book again and using your example that I can use 99355 prolong 30min but the book is telling me that I have to 1st code 99354 (prolong 1st hour). So if the visit was a 99214 typically 25 min and we spend 60 minute then I would have to based the visit off time and code higher since the total visit was not 1 hour over 25 min but only 35 min over 25 min to equal 60 min, Correct?
 
Yes you must use a 99354 but you must be a minimum of 30 minutes over the visit time. So for a 99214 you would need a minimum of 55 minutes documented. Then you use the 99214 plus the 99354. Look at the table provided in the book , assuming you have the AMA version. You would need to be 15 minutes over the hour of the 99354 to add the 99355. So for a visit of 100 minutes total you would subtract visit time, so a 99214 being 25 minutes you have 75 minutes left. The first 30-60 minutes is the 99354, then because you are 15 minutes into the next 30 minute segment you can add the 99355 as well so in that case:
99214
99354
99355
I hope this helps clarify.
 
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