AAPC - Back to school
Results 1 to 4 of 4

Thread: 99354 reimbursement

  1. #1
    Join Date
    Apr 2007

    Question 99354 reimbursement

    AAPC: Back to School
    Hi everyone. I just received a denial from united healthcare on the prolonged code 99354 stating charge is included in the global service. I have other carriers who are paying this code with no issue. Has anyone else run in to this situation? If so, did you appeal? Thanks

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Yes you appeal, to deny this is popular with united in my experience, however with a good appeal it has always been successful. Your documentation must have face to face physician time documented in the physicians progress note, I have had some difficulty recently when the physician did not document as time in and time out as opposed to total time spent. If this is not documented by the physician then an appeal will not be successful.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007

    Default 99354 reimbursement

    Thanks i will recheck the documentation and appeal this denial. This particular doctor is very good with her notes so i will give it a try.

  4. #4
    Join Date
    Apr 2007
    Ft. Myers, FL

    Default UNHC 99354 denials

    I too have found UNHC to stereotypically deny the prolonged code on the initial submission. As a matter of fact, this is so common in our practice, that we have a form letter where we just change specific claim/patient info in the letter and send it off with a copy of the note. I do agree that you need to make sure your doc's notes specifically indicate total face to face time spent with patient. I have never been denied an appeal from United after the letter and chart notes are sent. Sometimes it seems insurance companies purposely deny additional codes initially in hopes that providers just write them off and don't pursue an appeal. UGH!

Similar Threads

  1. 99354
    By pajohnson in forum E/M
    Replies: 8
    Last Post: 06-19-2013, 11:07 AM
  2. Help please 99354/99355
    By TLC in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 06-14-2012, 04:10 PM
  3. Question about 99354
    By EK226 in forum E/M
    Replies: 2
    Last Post: 09-16-2009, 02:21 PM
  4. 99354 need modifier?
    By kmeadows in forum Modifiers
    Replies: 4
    Last Post: 08-06-2009, 04:02 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.