prolonged visit coding Help!

codecrazy

Networker
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97
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:confused::confused:On the grid from CMS it shows typical time for 99201 as 10, threshold time to bill 99354 is 40, threshold for 99354 and 99355 is 85. 10 + 30 +30 = 70 so we have an extra 15 minutes. I figure this is because we do not code for the first 15 minutes, but cannot find documentation from a reputable source to explain the 15 minutes.
 

mitchellde

True Blue
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13,532
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Columbia, MO
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99354 is a code forthe first 60 minutes beyond the E&M time and 99355 is for the next 30 minutes beyond the first 60 minutes of the 99354:
So to bill a timed code you must have a minimum of one half of the required time spent
99354 is then 30 to 60
99355 is for the next 15 to 30 minutes beyond the 60
So
99354 then is for 30 to 74 minutes beyond the E&M
99355 is for 75 to 104 minutes beyond the E&M and adds on to the 99354
So for 85 minutes with the 3 key components to equal a 99201
99201 10 minutes leaving 75
99354 the first 30 to 74 of the 75
99355 75 to 104
 

hewitt

Expert
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Not sure if this will help, but the AMA's "CPT Changes 2012: An Insider's View" states, "Code 99355 or 99357 is used to report each additional 30 minutes beyond the first hour, depending on the place of service. Either code may also be used to report the final 15-30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately."
 
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