Wiki billing for special services


East Haven, CT
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I was wondering if anybody can offer me some advice on guidelines for billing special services. In regards to billing for prolonged services (99954 and 99355)for a follow-up visit where you are mostly counseling the patient and family members. Or just for a regular office visit or consult. Also on codes 99000, with regards to handling specimens? We do a lot of tissue biopsies, can that be used for tissue and or culture swabs from excisions. And also on code 99051 or a 99058? We occasionally see patients on a saturday when our office is normally closed. Can that be billed in addition to the office visit? These special codes are new to me and I want to bill properly and get it right and see if I can utlitlize them. I appreciate any guidelines or suggestions anyone can offer...thanks!!


I know that
*99354 and 99355 is for prolonged service use for Office and other outpatient that requires intermittent physician face-to-face time with patient over a period of 2-3 hours. Please remember that prolonged services codes 99354-99357 are not paid unless they are accompanied by the companion codes as described here.
The companion E&M codes for 99354 are:
-Office or other outpatient visit codes (99201-99205, 99212-99215),
-Office or other outpatient consultation codes (99241-99245),
-Domiciliary, rest home, or custodial care services codes (99324-99328, 99334-99337),
-Home services codes (99341-99345, 99347-99350).
The companion E&M codes for 99355 are 99354 and one of its required E&M codes.
*99000 is CPT code 99000, "Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory," is intended to be reported when the practice incurs costs to handle and/or transport a specimen to a lab. But Code 99000 is not intended for reporting the obtaining of a specimen. Reimbursement for obtaining a Pap smear or a throat culture is factored into the relevant lab procedure code. Also, obtaining a blood specimen by venipuncture may be reported separately, using code 36415,
*99051 &99058 is not reimbursement although additional with E&M, too.
I hope it help :cool:
Mostly counselling

Your first question asks about using the prolonged service codes "for a follow-up visit where you are mostly counseling the patient and family members."
Are you using time to determine the level of E/M? Or are you basing the level of E/M on meeting the bullet points in History, Exam, MDM?

Let's say your documentation meet the bullet points for a 99213 office visit. THEN your physician would ALSO document something along the lines of "an additional 35 minutes was spent counseling patient and family members about the prognosis of his disease, treatment options, risks and benefits." This last statement would qualify you to ALSO bill 99354. Note the phrase "an additional 35 minutes" - that clearly indicates that this time was prolonged service.

Now, let's say that you are choosing your E/M level based entirely on the total time spent with the patient in direct face-to-face contact. Your documentation might read something like this: A total of 50 minutes was spent with the patient and his family, 35 minutes of which was in counselling and coordination of care, discussing the prognosis of his disease, treatment options, risks and benefits." This example would allow you to bill 99215 ONLY. Why? Because the threshold for 99215 based on time spent on counselling/coordination of care is 40 minutes. So you'd subtract 40 minutes from the total spent; leaves you with only 10 minutes in this example... which isn't enough to bill the prolonged service code. And, no, you can't bill 99213 plus 99354 in this scenario. If you are using time to determine the level of E/M,you bill the highest E/M that the time supports FIRST, and only if you have additional time beyond that do you look to the prolonged service codes.
So to bill BOTH an established office visit AND prolonged service based strictly on total face-to-face time spent you need to have at least 70 minutes total time documented, with 36 minutes or more spent in counselling/coordination of care (that would be 99215, +99354)

Fortunately for us all, these scenarios don't happen too often. Which is also UNfortunate, since it's hard to remember the rules when you don't use them every day.

Hope this helps.

F Tessa Bartels, CPC, CPC-E/M
cpt 99000

:eek: Would it be correct to code 99000 for all specimens sent to an outside lab? Our outside lab provides packing materials for specimens and they do all the pick up. It does require some extra time to prepare specimen for transport. I want to know if it is correct to charge 36415 for lab venipuncture and 99000 for sending specimen out. We also normally charge for the lab procedure itself with the lab company billing us for their services.