Oncology & Hematology Coding Alert

Question: Our physician provided a one hour E/M service, most of which was spent on counseling, so we reported 99215 and one unit of +99354. An outside auditor came to our practice, said we should not have reported +99354, and told us to write our payer and give back the reimbursement we received for this extra charge. Is this accurate?Ohio SubscriberAnswer: Your auditor is correct. You can add +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour) only if your physician spent an additional 30 to 74 minutes beyond the typical time of 40 minutes allotted for 99215. In your case, the physician spent a total of 60 minutes on the service. He'd need to spend at least 70 minutes total (40 minutes plus at least 30 minutes) to report 99215 with +99354.Example: Your physician spends 75 [...]