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Coding Question - potiential illnesses

  1. #1
    Question Coding Question - potiential illnesses
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    One of my doctors came to me stating that preemie newborns take additional time during well child visits due to potiential illnesses due to being preemie. She asked if there was a way to bill so that we may get additional payment for the additional work, extended time.

    At first thought I say bill the 99391-25 with an ov E/M for the medical dx. But I was curious if anyone had any additional ideas/comments.

    Any input is greatly appreciate,

    Cheryl Miles - CPC

  2. Default
    I know there are prolonged visit codes

    99354- 30-74 minutes
    99355- each additional 30 minutes.

    But I am pretty sure any extra time MUST be documented in the chart and if it is less than 30 minutes, they can't report prolonged visits.

    Maybe some of the experts out there will have better codes to use or some additional information about the prolonged service codes.

  3. #3
    I'm familiar with those codes however insurances tend not pay them like the after hours code 99058. That was my other thought when talking it over with our other coding staff.

    Cheryl Miles, CPC

  4. Default
    My experience with the Preventative and an E/M in the same day is that most insurances will not pay for both, they usually only pay for the cheaper office visit rather than the well child check. But again, this is just my experience.

  5. #5
    Columbia, MO
    first th prolonged visit codes cannot be appended to preventive and second I have never had an issue getting them paid. But you must have good medical necessity to make it work. You are wanting to use additional codes for a preventive visit just to due to the complexities of a premie. You can have a split visit only if the pateint is comming for a preventive encounter and also has a symptomatic concern to address. What you have described sounds just like a preventive visit.

    Debra A. Mitchell, MSPH, CPC-H

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