Debra is absolutley correct. CPT clearly indicates that 99354 is used in conjunction with CPT codes 99201 through 99215, 99241-99245, 99324-99337, 99341-99350, 90809, 90815
99215 would be applicable in this situation...
Question: I spent 45 minutes face-to-face with a patient counseling them on how to manage their diabetes (in the non-facility setting). History, examination and decision making were consistent with code 99213. The combination of codes 99213 and 99354 pays more than code 99215, can I use the code 99213+99354 combination?
Answer: No. The dominant service was counseling and time is the correct basis of code selection. Therefore, the highest level of service must first be utilized before using a prolonged services code. Only code 99215 should be reported.
Per CPT Assistant.....
New language was also added to the guidelines to indicate that these add-on time-based codes require that the primary E/M service have a typical or specified time included in their descriptors. However, when counseling and coordination of care are not the dominant service (ie, time is not the basis of E/M code selection), the prolonged service code may still be used.
An example would be a patient who cannot hear, and the extra work of communicating with the patient requires more than 30 minutes beyond the typical time allotted for the E/M service.