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Use of Prolonged Service codes: 99354-99355

  1. #1
    Default Use of Prolonged Service codes: 99354-99355
    Medical Coding Books
    Hi all,

    I have a question regarding the use of face-to-face prolonged service codes: 99354-99355. Specifically, the use of these codes outside of the time component (i.e. more than 50% counseling &/or coordinating care) and additional time spent (i.e. "an additional 60 minutes spent discussing other treatment options").

    What if the physician documents the following scenarios:

    [B]Scenario #1:[/B] “The patient's primary language is not english and through the use of an interpreter, I have spent an hour with this patient and her family obtaining the history, exam, and medical decision making.” (Let's say the key components qualified for a 99214).

    Would I bill 99214 & 99354?

    Scenario #2: [I]" The patient is status post a CVA accident and has significant aphasia. This visit took 75 minutes to obtain the history, exam, and medical decision making" [I] (Let's say the key components qualified for a 99203)

    Would I bill 99203 & 99354?

    My concerns are with Medicare review audits. Is the documentation enough to support the above scenarios?

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default I would say "yes"
    I would say "yes" to both the scenarios you describe. There is a clear reason why the visit required extraordinary time. The key elements are used to determine the level of service. The total time spent is more than 30 minutes LONGER than the typical/average time spent for the level of service.

    F Tessa Bartels, CPC, CEMC

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