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99386 billed with 99354

  1. Smile 99386 billed with 99354
    Medical Coding Books
    Hi, Can anyone assist me in getting some information on this scenario. I work for a local insurance company in upstate NY. A provider is billing

    99386-preventive
    99354-prolonged

    total of 90 minutes face to face

    I needed to know if there is any documentation out there that can show why preventive visits cannot be billed with a prolonged service since the preventive visit is an E/M code? Is it because the preventive vists are age specific? Thanks

    99381-99397 Preventive Medicine Visits - (99381-99397)
    99354-99357 Prolonged Services Direct Contact - (99354-99357)

    CPT code manual states
    "(use 99354 in conjunction with 99201-99215-, 99241-99245, 99324-99337, 99341-99350, 90809, 90815")

  2. #2
    Smile
    Quote Originally Posted by adecker View Post
    Hi, Can anyone assist me in getting some information on this scenario. I work for a local insurance company in upstate NY. A provider is billing

    99386-preventive
    99354-prolonged

    total of 90 minutes face to face

    I needed to know if there is any documentation out there that can show why preventive visits cannot be billed with a prolonged service since the preventive visit is an E/M code? Is it because the preventive vists are age specific? Thanks

    99381-99397 Preventive Medicine Visits - (99381-99397)
    99354-99357 Prolonged Services Direct Contact - (99354-99357)

    CPT code manual states
    "(use 99354 in conjunction with 99201-99215-, 99241-99245, 99324-99337, 99341-99350, 90809, 90815")
    OK--They should have billed it as a preventive code then a counselling code (99401 - 99403) instead....Lots of offices don't utilize those counselling code but it is better. Hope this helps..
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

  3. #3
    Location
    Columbia, MO
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    You canot append the prolonged codes to the preventive codes as it is not allowed by CPT conventions and the preventive visit levels have no timed component for the visit itself.

    Debra A. Mitchell, MSPH, CPC-H

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