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Billing Office visit beyond 40 minutes

  1. #1
    Default Billing Office visit beyond 40 minutes
    Medical Coding Books
    Hello!

    If Physician spend more than 40 minutes (e.g. 55 minutes or 80 minutes), how will I bill additional time beyond 40 minutes. I bill 99215 which cover 40 minutes but I don't know which additional code I should bill to cover more than 40 minutes time spent face to face with patient. Please advise.

    Thanks

  2. #2
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    Columbia, MO
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    You should look at the prolonged time codes 99354-99355 and the rules. The minimum amount of time that must be documented is for a 99215 plus a 99354 is 70 minutes, the minimum for a 99215 plus a 99354 and a 99355 is 115 minutes. Also note that these can be appended to any visit level and are not restricted to a 99215 or 99205. So if you have a 99213visit level that took 45 minutes you can bill the 99313 plus the 99354. The Medicare manual has an entire section on these codes with a table of the visit levels and the minimum times.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Quote Originally Posted by mitchellde View Post
    You should look at the prolonged time codes 99354-99355 and the rules. The minimum amount of time that must be documented is for a 99215 plus a 99354 is 70 minutes, the minimum for a 99215 plus a 99354 and a 99355 is 115 minutes. Also note that these can be appended to any visit level and are not restricted to a 99215 or 99205. So if you have a 99213visit level that took 45 minutes you can bill the 99313 plus the 99354. The Medicare manual has an entire section on these codes with a table of the visit levels and the minimum times.

    Thanks for response. I was under impression that to bill 99215+99354 Physician should have spent 45+60=105 minutes but I think it is wrong.

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