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Thread: Billing Prolonged Services

  1. #1
    Join Date
    Apr 2007

    Default Billing Prolonged Services

    AAPC: Back to School
    I am reviewing a neurologist billing prolonged services. For one patient this neurologist billed 99215 (Comprehensive Exam), 99354 (Prolonged Services, 1 hr., face to face), along with 96110 (Developmental Testing), and 96116 (Neurobehavioral status exam). This neurologist has scheduled two hours between patients. It appears this physician is billing the prolonged services for time spent administering the tests billed. However, the tests include the physicians time. Anyone else have any experiences with this type of billing?
    Last edited by eeoo; 03-24-2010 at 09:00 AM.

  2. #2
    Join Date
    Apr 2007
    Everett, WA


    I will defer to my more knowledgable colleagues. Our neurologist practice has patients that require infusions for acute headache care. We cannot charge for the infusion time as that is a component in the code itself. The patient may well be in the office for several hours, but the prolonged service code is only justified if the doctor is able to document that he spent the minimum additional time required with the patient as set forth by the prolonged service codes criteria. Hoping others will comment...
    Suzanne E. Byrum, CPC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Prolonged service

    The prolonged service codes are times based. The time must be UNIQUE to prolonged service. Time spent in providing other services which are separately billable CANNOT be used to support prolonged service.

    So, NO, the time spent administering tests or providing treatment which are separately coded/billed cannot be used to support prolonged service.

    F Tessa Bartels, CPC, CEMC

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