Robert Posted Sat 27th of April, 2013 01:02:34 AM
Is their any additional codes billable/allowable thru medicare for time Dr. takes to consult with another physician via phone/fax to discuss patients plan of care or research the Dr. does before patient is scheduled to come back for a follow-up??
SuperCoder Answered Tue 30th of April, 2013 02:49:35 AM
You just include the work in the level of service you determine for the next E/M service, and there is no separate way to bill for it.
Remember that codes +99354–+99357 are time–based and are add–on codes. You do not need to append a modifier to these codes and you should not decrease their reimbursement when billed with other primary E/M codes.
Important: Remember that there is a 30–minute threshold time with the prolonged services codes before those codes kick in. In other words, include 30 minutes more beyond the usual time for the reported E/M service before using the prolonged services codes.
Example: Your physician spends 75 minutes face–to–face visiting with a 79–year–old patient who has several comorbid conditions. The patient's son is present, as well. The doctor goes over the problems and counsels the family on potential solutions with the patient present. "Counseling" is an important word to use as it helps to support coding based on time.
In this example, you'll report one unit of 99215 to cover the first 40 minutes, plus one unit of +99354 for the extra 35 minutes of face–to–face prolonged services.