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Marilyn Posted Wed 07th of August, 2013 20:19:04 PM

Pt seen for 90837 (60min) +30min. Is there a prolonged code to use for the 30min?

SuperCoder Answered Thu 08th of August, 2013 04:29:44 AM


It is written below code 90837 --

(Use the appropriate prolonged services code [99354-99357] for psychotherapy services not performed with an E/M service of 90 minutes or longer face-to-face with the patient)

Marilyn Posted Fri 09th of August, 2013 16:06:17 PM

So Dr spent 90 minutes with patient. I would just bill 99354 or is it 90837 + 99355?

SuperCoder Answered Fri 09th of August, 2013 21:11:56 PM

90837+99354 for 90 minutes. 89 minutes total would just be 90837. Although 99354 says first hour, a minimum of 30 additional minutes (the half-way mark) allows reporting 99354. Fortunately CPT® Assistant, May 2013; Volume 23: Issue 5, had a very similar question

Medicine: Psychiatry

Question: If the psychologist spends 90 minutes with the patient, will he/she be allowed to report code 99354, Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service), as a way of capturing the prolonged time?

Answer: It would depend on the service provided and the base code used to report the service. If the psychologist is reporting the Health and Behavior Assessment/Intervention codes, the prolonged service codes would not be used, as codes 96150-96155 are time based and multiple units of the codes can be reported to represent services up to and beyond 90 minutes. The prolonged service codes (99354-99357) are also not reportable with code 90791 Psychiatric diagnostic evaluation. However, if the psychologist reports 90837 for psychotherapy that requires 90 minutes, code 99354 may be reported for the additional time.

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