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Prolonged visit billing by different doctos

  1. Question Prolonged visit billing by different doctors
    Medical Coding Books
    Can two providers from the same group practice, same specialty, who see a patient on the same date of service at separate times bill as if they are one provider? Such as one bill 99223 and the other bill prolonged visit 99356?
    Last edited by sadieb; 03-18-2008 at 04:12 PM.

  2. #2
    Central Arkansas
    No because in order to use the prolonged services you would have to have a high level OV, ie. 99215 or 99205 by the same provider.

  3. #3
    Milwaukee WI
    Default Right Answer / Wrong Reason
    Boyerj states that you can only bill prolonged services on the highest level E&M ... that is incorrect ... See CPT explanation of Prolonged Service on pg 28 of CPT 2008 Professional Edition: "This service (CPT 99354-99357) is reported in addition to other physician services, including evaluation and management services at any level." (emphasis added by me)

    But the answer is still No ... each provider bills his/her own service level. If you payor is only going to pay for one service, I'd bill out the one that had the highest level documented.

    If the two visits were by the same physician, s/he would have to document time on the second visit of 30+ minutes over and above the original E&M visit in order to bill prolonged service.

    F Tessa Bartels, CPC

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