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99354

Stephnaie Posted Thu 12th of June, 2014 10:58:11 AM

Can 99354 (prolonged svc) be used when the doc counsels a patient for 40 minutes on weight loss? Thank you.

SuperCoder Answered Thu 12th of June, 2014 12:28:26 PM

Thanks for your question.

Prolonged services are billed when a provider provides direct face-to-face contact to a patient that is beyond the usual service. 99354 is billed when the prolonged service takes 30 to 74 minutes. This time is calculated after the time for the primary office visit.

Remember in order to bill based on time the provider must spend half of the visit on counseling and coordination of care. You will need to determine the time for the E&M code that you would like to bill based on documentation. Ex. 99213 which is typically 15 minutes in duration. You would subtract the time for the prolonged service 40 minutes from 15 minutes for the 99213 and this could leave 25 minutes which is less than the required time for prolonged services billing.

See CMS Med Learn Matters article on Prolonged Services.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5972.pdf

Hope this helps.

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