tobeornottobeacoder
Networker
Gilenya
This has been a discussion on this forum already but it was from a couple of years ago. I want to start this back up and see if any new developments have come from it. Previous discussions about this drug was how to bill for 6 hours of observation for the first dose on this drug. Many suggestions were made on how to bill for this 6 hours and a few mentioned using prolonged services. According to a comment left by member KMABE on 5/19/2011, she stated that after a few denials and researching she found that it was appropriate to bill an E/M code plus the prolong service code 99354 x 1 unit. She said she was getting payment on the charges mostly from MCR. Another comment made from Rebecca Leeper on 8/18/2011 that she also agreed with KMABE and that the only truly compliant way to bill for this is to note the quality and quantity of the actual time spent face to face with the patient and only bill for that and any prolonged services. It states in the CPT "Codes 99354-99355 are used to report the total duration of face to face time spent by a physician or other qualified healthcare professional on a given date providing prolonged service in the office or other outpatient setting, even if the time spent by the physician or other qualified healthcare professional on that date is not continuous." I would like to hear any comments from anyone who has recently experienced this issue and how did you resolve it? By doing the above? Did you have to arrange payment with each payer? or preauth services? Any comments please.
This has been a discussion on this forum already but it was from a couple of years ago. I want to start this back up and see if any new developments have come from it. Previous discussions about this drug was how to bill for 6 hours of observation for the first dose on this drug. Many suggestions were made on how to bill for this 6 hours and a few mentioned using prolonged services. According to a comment left by member KMABE on 5/19/2011, she stated that after a few denials and researching she found that it was appropriate to bill an E/M code plus the prolong service code 99354 x 1 unit. She said she was getting payment on the charges mostly from MCR. Another comment made from Rebecca Leeper on 8/18/2011 that she also agreed with KMABE and that the only truly compliant way to bill for this is to note the quality and quantity of the actual time spent face to face with the patient and only bill for that and any prolonged services. It states in the CPT "Codes 99354-99355 are used to report the total duration of face to face time spent by a physician or other qualified healthcare professional on a given date providing prolonged service in the office or other outpatient setting, even if the time spent by the physician or other qualified healthcare professional on that date is not continuous." I would like to hear any comments from anyone who has recently experienced this issue and how did you resolve it? By doing the above? Did you have to arrange payment with each payer? or preauth services? Any comments please.
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