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Marilyn Posted Mon 16th of October, 2017 12:55:43 PM
My doctor is billing 90834 with 99355. Is this correct? Should it be 99354 for first addt'l hour then 99355 for additional?
SuperCoder Answered Tue 17th of October, 2017 02:35:14 AM

HELLO

Yes it is appropriate to bill CPT 90834 along with prolonged service codes. In the office or other outpatient setting, Medicare will pay for prolonged physician services (CPT code 99354) (with direct face-to-face patient contact that requires 30 minutes beyond the usual service), when billed on the same day by the same physician or qualified NPP as the companion evaluation and management codes. The time for usual service refers to the typical/average time units associated with the companion E&M service as noted in the CPT code. You should report each additional 30 minutes of direct face-to-face patient contact following the first hour of prolonged services with CPT code 99355. You may use code 99355 to report each additional 30 minutes beyond the first hour of prolonged services, based on the place of service. These codes may be used to report the final 15 – 30 minutes of prolonged service on a given date, if not otherwise billed. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.

In order to bill prolonged service codes along with psychotherapy code 90834, the minimum time spent must be 30 minutes beyond the usual time given in the code descriptor, for e.g. in CPT code 90834, 45 minutes is the usual time and 30 more minutes must be spent with the patient in order to code prolonged service code 99354. Prolonged time spent less than 30 minutes will not meet the criteria to bill for prolonged service codes. If prolonged time spent is from 30 to 74 minutes, report CPT 99354 x 1. If prolonged time is between 75 and 104 minutes, report CPT 99354 x 1 and 99355 x 1. If prolonged time spent is more than 105 minutes, report CPT 99354 x 1 and 99355 x 2. CPT code 99355 will be reported when 30 minutes are spent beyond initial prolonged time of 30 minutes, i.e. for initial 1 hour prolonged service time.

HOPE THIS HELPS!

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