I've had a little experience with getting Anthem to pay for this 99354 Prolonged Service with Direct (face-to-face) patient contact, but it does take some time and perseverance and be prepared to follow the chain of instructions. It took us 10 months to get the last 99354 paid. I suspect part of the issue might be with the way that your physician documents his services in Anthem's eyes and may have to do with the time element in the 96118 in the "combo" type of chart notes, but is a guess on my part. You mentioned getting a hold of an Anthem rep....did you contact one from the Escalated services agents after normal customer service fails? Our neurology specialist is having some issues with another code, and we've had to enlist the support of escalated services. Unfortunately, they're not always quick to respond, so you may have to stay on their trail, email, call and log a good thread of documentation. It can be very frustrating....
I know this didn't directly answer your question, but at least let you know there are others out here who have and are experiencing similar issues. I'm hoping others more experienced with this type of coding scenario will respond.
---Suzanne E. Byrum CPC
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