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Prolonged Services and Procedures

  1. Exclamation Prolonged Services and Procedures
    Medical Coding Books

    If I have a patient that comes in and the service is equal to a 99214 (25 min) and the doctor also documents additional face to face time counseling the patient, etc. an additional (60 min) and then she gives the patient Botox injections (30 mins)...would you code
    99354 x 1
    64612-50 x1

    or do you also count the time it took to do the procedure in prolonged services? I have a doctor that thinks she should get the additional 30 min for the procedure (CPT 99355) because it's face to face time. I told her the time is already included in the procedure and that it's not included in the face to face time. Please help me! If I am wrong I want to do it right!


  2. Default
    Procedure time can not be counted as part of E&M or prolonged time.

    But are you saying the Physician spent 2 hours total with this patient? She took 25 minutes to provide the 99214 service then counseled the patient for another 60 minutes before doing a procedure that took 30 minutes? Is that right?

    That's a lot of time. Does she have "sufficient documentation" to support that extra 60 minutes. Did she document procedure time?

  3. #3
    Everett, WA
    Default more clarification needed...
    That is indeed a lot of time..

    Even if all is proper and legitimate, the time utilized in the botox procedure can't be counted for prolonged service time. That is indicated by the instructions in the CPT guidebook from the last sentence in the first paragraph in the Prolonged Services Category. From what I see the prolonged service code is 99354 (1) for 30-74 minutes of face-to-face time. DISCLAIMER: I'm still in student mode studying EM principles so will defer to the fellow experts in this area.

    Suzanne E. Byrum, CPC

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