Medicare Compliance & Reimbursement

Reader Questions:

Limit Prolonged Services to Highest Category in 1 Instance

Question: Can the prolonged codes (+99354, Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management service]) and +99355 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; each additional 30 minutes [List separately in addition to code for prolonged physician service]) be billed with all established patient office visit codes (99211-99215)? For a 60 minute face-to-face visit, could I report 99214 with 99354? Or can I only report 99354 with 99215? Answer: A few points need to be clarified so you're not mixing apples and oranges. CPT 2009 deleted modifier 21, which was a prolonged service modifier that could be used on only the highest E/M level in a given category. You could use [...]
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