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Question about 99354

  1. #1
    Default Question about 99354
    Medical Coding Books

    I have a question about using 99354. I have a physician who is seeing a new patient and billed w/ 99202 and 99354. The office notes state that the patient was initially seen in an ER a week prior and was diagnosed with a venous embolism deep vein distal lower extremity. He is presenting to the office today and the following was performed:

    "The dorsalis pedis and posterior tibular pulses were 1 bilaterally. One leg balance was within normal limits. The patient was able to lift up to 100 pounds occassionally and 50 pounds continuously. The patient was able to climb a ladder without any problems. He performed balance and lifting tests, heel and toe walks. Fifty minutes were spent w/ the patient and I filled out return to work forms."

    99354 states it is used to report the first hour of prolonged services for face-to face care that is beyond the usual service in either inpatient or outpatient settings. So what would normally constitue for "beyond the usual service"? Is it the fact that the physician performed all of these tests, plus spending 50 minutes w/ the patient?

    Any suggestions?
    Emily Kress, CPC

  2. #2

    Not sure who your carrier is but the above has really detailed info on using those codes. Based on what you have posted, it looks like the coding would be correct as described in this situation, assuming the documentation supports a 99202 based on key components.

    Laura, CPC, CEMC

  3. #3
    Hi Laura,
    Thank you for the information you provided, and for the web site info as well. As far as I can see, the rest of the documentation does support the 99202.

    Thanks again for your help!

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