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Extended E&M

  1. Default Extended E&M
    Medical Coding Books
    Just wanted to make sure: 99354 is billed in addition to appropriate E&M w/ same DX and NO mod. RIGHT???

  2. Default
    That is correct

  3. #3
    Smile 99354
    CPT's prolonged services codes (99354-99357) should be used only when you've exceeded the time component for the appropriate evaluation and management (E/M) visit. No modifier needed and same Dx is used.

  4. #4
    North Carolina

  5. Default
    Thank You ALL !!!!

  6. Default
    It would have to be above a 99215. Has anyone ever billed and paid for prolonged services?

  7. #7
    Columbia, MO
    It does not have to be above a 99215, a 99354 can be appended to any visit level, I have coded this way many times and always been reimbursed by every carrier. The reimbursement is always excellent.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    North Carolina
    Debra is absolutley correct. CPT clearly indicates that 99354 is used in conjunction with CPT codes 99201 through 99215, 99241-99245, 99324-99337, 99341-99350, 90809, 90815

    99215 would be applicable in this situation...

    Question: I spent 45 minutes face-to-face with a patient counseling them on how to manage their diabetes (in the non-facility setting). History, examination and decision making were consistent with code 99213. The combination of codes 99213 and 99354 pays more than code 99215, can I use the code 99213+99354 combination?

    Answer: No. The dominant service was counseling and time is the correct basis of code selection. Therefore, the highest level of service must first be utilized before using a prolonged services code. Only code 99215 should be reported.

    Per CPT Assistant.....

    New language was also added to the guidelines to indicate that these add-on time-based codes require that the primary E/M service have a typical or specified time included in their descriptors. However, when counseling and coordination of care are not the dominant service (ie, time is not the basis of E/M code selection), the prolonged service code may still be used.

    An example would be a patient who cannot hear, and the extra work of communicating with the patient requires more than 30 minutes beyond the typical time allotted for the E/M service.

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