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98962 and prolonged services

  1. #1
    Richardson, TX
    Default 98962 and prolonged services
    Medical Coding Books
    If the patient comes in for Medication management but the session prolongs for 40 to 45 min, can we bill office visit or therapy code?

    The doctor is asking us to do 99354.

    Appreciate if some one could share their way of billing this service.


  2. Default prolonged service code
    To use the prolonged service code there must be clear documentation of how much time was spent, why prolonged time was needed and what exactly was done for that prolonged period of time. Read the guidelines in front of the Prolonged services section in the E&M section for more information.

  3. #3
    Columbia, MO
    99354 cannot be billed by itself and can be appended only to certain codes such as office visit or the highest level behavioral codes 90809 and 90815 I believe are the numbers, the list is in the CPT book if you look just under the 99354 descriptor. If the code you have is not listed there then you cannot use the 99354. Also the 99354 can be appended only to codes that have time as a component. To use 99354 the total time spent with the patient must be more than 30 minutes over and above the code you are using. For example for a 99213 you must have a minimum of 45 minutes spent with the patient.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Example of using 90809 w/99354
    Psychologist, social worker and or Ph.D spends a total of 2.5 hours [150min] with patient even though the total time wasn't continuous - basically, in and out of patient room.

    90809 75 min
    99354 60 min

    15 minutes remain which is absorbed into the 99254 because the time isn't above the 30 minute continued time frame.

    Correct OR Not Correct - please clarify if possible and THANK YOU!
    Cheryl Odquist,CPC
    San Diego

  5. Default
    The 98962 is not a code used for medication management. That code is for Education and Training for Patient Self Management within a group setting. Medication management is billed using 90862 is not a timed services. It is an encounter code. Therefore you would not be able to add a prolonged service to the code.

    I was also under the impression that prolonged services could only be added to E/M services. The 908__ are psych services. Some of those have the med management component as part of them.
    Last edited by MAnderson09; 11-11-2011 at 12:12 PM. Reason: clarification

  6. #6
    Columbia, MO
    the 90809 and 90815 were added to the ist of valid codes the 99354 can be appended to. For the 90809.for 150 min. The 90809 goes to 80 min which leaves 70 so yes you may add the 99354, 30 to 74 minutes is the 99354 at 75 minutes you may add the 99355 as well

    Debra A. Mitchell, MSPH, CPC-H

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