Wiki prolonged services question

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wbradhoward

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When attempting to determine the appropriate E/M codes to use when an extensive amount of time has been spent with the patient (and documented appropriately :) ), how do you figure out the initial E/M code to use?
For example, if you have a 90 minute established patient office visit, do you automatically have to use the highest level est. pt code 99215 with 99354? Or can you bill a 99213 with 99354 and 99355? What determines the established visit code (99211-99215) that you use in conjunction with the prolonged visit code?
 
You code the visit level based on what is met by the three key components. So if the components equal a level 3 then a 99213 is what you code. A 99213 is allotted 15 minutes on average, you take total time spent and subtract the 15 minutes, so in your example, 90 minutes less the 15 leaves 75. 99354 is 30-74 minutes, 99355 is 75- 104 min so you would bill the 99213, 99354, and the 99355.
 
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