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If you report add-on codes, make sure to report an E/M code and avoid denials
Prolonged service codes (99354-99359) may hold the key to boosting your pay when your dermatologists spend more than the usual face-to-face time allotted for E/M services.
Remember: Prolonged service codes are add-on codes, so you shouldn\'t ever report prolonged service codes alone, coding experts say.
Here is a closer look at the prolonged service codes, when to use them, and what your prolonged service claim should look like before sending it to the carrier.
Setting Determines the Prolonged Service Code
A dermatologist performs a level-two E/M service on an established patient that takes 45 minutes.
For example: A patient comes for a routine skin exam. During the exam, the patient tells the dermatologist that a specific mole has been itching and bleeding. The dermatologist ends up spending more time with the patient than a level-two E/M service typically takes (about 10 minutes).
In this case, you should report a prolonged service code with the E/M code on this claim. The claim should read:
Tip: Use 99354 for the first 30-74 minutes of outpatient prolonged service time and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) for each additional half-hour for outpatients beyond 74 minutes.
Remember: To use the first-hour prolonged service codes, the dermatologist must provide at least 30 minutes of prolonged service time beyond the CPT-allotted time for that E/M service, coding experts say.
Bottom line: The prolonged service time must be face-to-face time between the physician and patient. If you haven\'t met that requirement, the prolonged service codes are not applicable.
In general, you should not upcode the level of E/M service based on time; only raise the level of E/M service if the dermatologist provides a higher level of service.
In order to report the E/M code on time, without prolonged care, [...]
- Published on 2005-04-13
