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Prologed services 99354

struk

Contributor
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Based on the discription from the manual this code can be used when the doctor spent 1 additional hour face to face with the patient in addition to E/M code? Not 30 min.?? Correct?
So if it is beyond 30min I cannot use it. Or if it is beyond 1 hour I cannot use it?
 

tfreeland

Contributor
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I use this code a lot in FP. If you have the documentation for a 99213 but the provider ended up spending at least 31 extra minutes with the patient for counseling, answering questions, etc., you can bill for the 99213 for the first 15 minutes and 99354 for the additional 31+ minutes up to 1 hour. 99354 and 99355 should NOT be billed with a 25 modifier on the E/M code. Remember to document your start and stop times and what was discussed requiring the extra time.

BTW - I have confirmed this info with the billing consultants at the Texas Medical Association and have had no problems with reimbursement.

:)

Terri Freeland, CMM, CFPC
 
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