99354 --> RE: Billing for long visits

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March 2004 Table of Contents

Coding & Documentation

Answers to Your Questions

Kent J.

Covered in FPM Quiz

Prolonged services codes

Q I read recently that CPT's prolonged services codes (99354-99357) should be used only when you've exceeded the time component for the appropriate evaluation and management (E/M) visit code by at least 30 minutes. So, for example, to submit 99354 in addition to 99214, which is listed in CPT as 25 minutes, is it true that the total face-to-face time would need to be at least 55 minutes?

A Yes. To code 99354 with 99214, the total face-to-face time spent with the patient would need to be at least 30 minutes beyond the 25 minutes typically spent in a 99214 visit.

Locke, MD

From: [mailto: ] On Behalf Of Sent: Saturday, May 17, 2008 10:45 AMTo: Subject: Re: Billing for long visits

-In the noteIn case i get auditted- I get paid -I do not look at my billing the way Joanne Holland says i should or i could tell yo more. Billing upsets meI take so few insruacnes that I can add up in my head what pittance I should get every day Then I know what tiny amount the biller should be putting in my account on friday-subject of course t o the 4-52 week delay of what you bill for and when you get it. I earn about what i thikn i am earningForgive me becasue Joanne would have me earn more I am sure but I CANNOT STAND IT!! I would rather sleep and have have mental health and 100.00 less a week. Ostrich is my middle name. that;s all I knowMy biller actually told me once I bill too little actually LESS THAN MEDCIARE WILL PAY for the 992454 thing but i could not' justify it actually And my biller does not pay much attention to me becasue t my littel practice is so wierd i got a nice big-for me- deposit yesterday and the chick who does my account, well she always tells me my deposit amount on fridays by email, unless she forgets ,and then I think oh god i earned nothing at all ,and yesterday she said get this ,told me the amount, and said it isnt a joke. That is how pathetic they think i amI actually SAVED money twice in the last 2 months This is probably not to the practcie alone but to the good will of certain outside forces that pay me to do other work can I vagule say...Mostly i feed us and we do ok but i sorta kinda live form pay check to paycheck Il ive BETTER from payheck to paycheck than last year.. At 3 yrs i continue to do better and better I just don;t do greatMy sorta friend who runs MAine care says we are getting in primary care only, a big pay hike injuly Probably i will get 32.00 not 28 for a 99213.....:)But go for it Annie it makes sense you do the work get every penny you can.99254 is a good thing.

"in the note" meaning in the chart note, not somewhere on the billing form (HCFA form)? Just in case of audit some day?

Have you been paid on any of these? Have you been denied (if so, by whom?) Does Medicare allow it?

annie

i do this all the time i do not use a modifier the time just goes in the note "47minutes " i do not do the" 1 pm to 2 10 pm" thing except sometimes.

I have never tried billing a 99214 plus 99354, but have heard that if I spend an hour with a patient mostly counseling and I bill this way I will get more than if I just bill the 99215. If I do this, do I use the -25 modifier, and if so, on which code? I've also heard that I must include my times in and times out; Where do I record those? Thanks,-- Annie SkaggsLexington, KY

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax

-- Annie SkaggsLexington, KY -- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax