Practice Management Alert

Recoup $105 Extra Per Visit With Prolonged Services

Billers sometimes choose not to report prolonged services because they believe carriers won't reimburse the codes. Although not all carriers will pay, it's worth a try: You may be missing out on at least $105 per visit if you're not reporting prolonged services.

Here's how: You can bill extended services using prolonged service codes (99354-99359) if the total reported time exceeds the typical time of the appropriate E/M code, as outlined in CPT, by at least 30 minutes. Prolonged service codes allow you to report the total amount of time the physician spends with a patient on a given date, even if that time is not continuous. Follow these easy steps to prolonged services reimbursement:

1. Select an appropriate E/M code first based on all components of the visit (history, exam and medical decision-making).

2. Calculate the total time of the service the physician documented by reviewing the start and stop times he recorded. Remember, the physician's time with the patient doesn't have to be continuous.

3. Choose the appropriate prolonged services code(s) to report the total amount of extended time the physician spent with the patient.

4. Don't confuse time requirements. Prolonged service codes report time over and above the particular E/M code you bill. You must have at least 30 minutes of reported services in addition to the time requirement for the E/M. If the extra time for the visit is less than 30 minutes, you can't bill for it using 99354-99359.