Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 13, 2003 PDF

Prolonged Services Codes 99354-99357 May Provide Answer

Most businesses love same-day repeat customers, but physician office managers groan when they see the same patient come back twice in one day.
 
Whether he's a hypochondriac or developing serious complications, that repeat visitor creates a dilemma: Can you bill for two evaluation and management services in the same day for the same person?
 
Maybe, experts say, but for the most part it's just not worth the trouble.
 
In the hospital, it may be possible to bill for two separate E/M services for different doctors, but in the office setting, it's really not done, says Deepa Malhotra, president of Healthcare Educational Resource Services Inc. in Aurora, Ill. Even if the patient saw two different doctors in the same specialty and group, you must bill them as if they were one physician.
 
"I never try to do two different codes even with different doctors," says Wendy Dicus, coding supervisor with Alaska Billing Services in Anchorage. "I've had too much experience being denied that way." She generally combines the two E/M services into a single code. "Usually, I'll end up having a higher level of service just by doing that."
 
You can actually receive up to $100 more reimbursement by combining two E/M services into one higher-level service, Dicus adds. A lower-level visit may reimburse between $60 and $90, meaning that two of those visits would be under $200. But "I could easily bill a visit that is $200 to $250 if I combine them," she says.
 
Even if the two separate visits did lead to higher return, it will most likely lead to a denial. "The time and effort it takes to appeal something like that usually isn't worth it," Dicus says. "I need to see the money make a difference before I bill out two different visits." She'll only bill for two separate codes if there's a critical care and a separate E/M visit.
 
Another way to make a blessing from the double visit is to use prolonged services codes 99354-99357, Malhotra says. As long as the physician or physicians spend at least 30 minutes face-to-face with the patient, you can add up those services to a much higher pay rate.