Code based on time and the 99354 code

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Can someone explain to me what the significant difference is to code soley based on time spent with the patient "face to face with over 50% was spent in C & C" and using the 99354 code? Do you use both at the same time, is one significantly different than the other or is it all the same thing?

I am having the hardest time figuring this out...

Can someone give me some scenarios to help me walk through this? Any help would be greatly appreciated..

P.S. I have already read through Medicare's Prolonged Service descriptions

Thank you!

dscoder74:confused:
 
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99354

let say the established asthmatic patient is scheduled for 25 min total time 20 min spent c&c - nothing else done. then code 99214

but if more is done and the patient ends up staying 1hr 30 min more - then code 99354 for the first hour 99355 for each additional 30 min


code 99214 + 99354 + 99355

time base visit (25min) + first hr more + 30 min more
 
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Prolonged Service is OVER and ABOVE E/M

Prolonged Service is for time spent face-to-face over and above the time for the E/M service.

It can be used in addition to ANY E/M code (except those that are intrinsically time-based, like Critical Care). It doesn't require ANY counseling/coordination at all.

If the physician spends at least 30 minutes over and above performing the E/M service, he can code the 99354 to reflect the prolonged time spent.
Theoretically you could code a 99211 E/M service AND 99354 if you spent 30 minutes over and above the E/M service documented.

But you can use the Counseling/coordination of care rule to code an E/M based entirely on time ... even with NO exam, NO history, NO MDM. So if you have a patient who comes in to discuss his concerns re upcoming procedure ... and you spend 15 minutes with him entirely in counseling/coodination of care, you can use that time to arrive at your 99213 E/M code.

And, as adonis_laurenteCPC noted in the previous post, you can combine these two. HOWEVER, if you are using Counseling/Coordination of care to determine the basic level of E/M, then you must code the highest level of E/M FIRST, and only then use the prolonged service if you have at least another 30 minutes of time remaning.

In the case of the asthmatic patient, I'd look first to the documentation bullets to see what level of service was documented ... for argument's sake let's say 99213. Then the doctor should also document something like "I spent an additional 90 minutes in direct face-to-face service with patient providing xxxx (whatever the service was, could be counseling)" This makes it clear that you have a documented level of E/M PLUS prolonged service (99354 and 99355).

Here's an example of counseling/coordination time being used for BOTH the E/M and prolonged service:
An established patient with a recent diagnosis of breast cancer who comes in for counseling/coordination of care visit to discuss the diagnosis, the treatment options, risks, benefits, etc. The doctor spends 80 minutes with the patient, face-to-face, 100% counseling & coordination of care. You would code 99215 (using the first 40 minutes of the time to establish the basic E/M) and 99354 (using the next 40 minutes of prolonged face-to-face service).

Note that for prolonged service it has to be OVER and ABOVE the time needed for completing the E/M service.

I hope this helps. If you want to post a scrubbed note, we can try to help you determine whether it is entirely a C/C note, an E/M w/ prolonged service, or a combination.

F Tessa Bartels, CPC, CPC-E/M
 

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Thank you, I have noticed that you offer great guidance to many questions posted on this site and to my entries personally...

Thank you,

dscoder74
 
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Jesuit education

You're welcome. I give credit first to the nuns who taught me to diagram sentences, and then to the Jesuits who guided my university education. REALLY teaches you to think and write logically (or so one hopes).

F Tessa Bartels, CPC, CPC-E/M
 
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