Sunday, April 8, 2012

cpt codes 99354 - 99357

Prolonged Physician Service with Direct (Face-to-Face) Patient Contact (99354-99357)


Codes 99354-99357 are used when a physician provides prolonged service involving direct (face-to-face) patient contact that is beyond the usual service in either the inpatient or outpatient setting. This service is reported in addition to the designated evaluation and management services at any level and any other physician services provided at the same session as evaluation and management services. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period.

Codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician on a given date providing prolonged service, even if the time spent by the physician on that date is not continuous. Codes 99356-99357 are used to report the total duration of unit time spent by a physician on a given date providing prolonged service to a patient, even if the time spent by the physician on that date is not continuous.

Code 99354 or 99356 is used to report the first hour of prolonged service on a given date, depending on the place of service.

Either code should be used only once per date, even if the time spent by the physician is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management codes.

Code 99355 or 99357 is used to report each additional 30 minutes beyond the first hour, depending on the place of service. Either code may also be used to report the final 15-30 minutes of prolonged service on a given date. 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.

The use of the time based add-on codes requires that the primary evaluation and management service have a typical or specified time published in the CPT codebook.

The following examples illustrate the correct reporting of prolonged physician service with direct patient contact in the office setting:

Total Duration of Prolonged Services    Code(s)

less than 30 minutes   -  Not reported separately

30-74 minutes (30 minutes - 1 hr. 14 min.)  -  99354 X 1

75-104 (1 hr. 15 min. - 1 hr. 44 min.)  - 99354 X 1 AND 99355 X 1

105 or more (1 hr. 45 min. or more)  -  99354 X 1 AND 99355 X 2 or more for each additional 30 minutes




99354Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service)

(Use 99354 in conjunction with 99201-99215, 99241-99245, 99324-99337, 99341-99350, 90809, 90815)

99355Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service;each additional 30 minutes (List separately in addition to code for prolonged physician service)

(Use 99355 in conjunction with 99354)

99356Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service)

(Use 99356 in conjunction with 99221-99233, 99251-99255, 99304-99310, 90822, 90829)

99357Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service;each additional 30 minutes (List separately in addition to code for prolonged physician service)

(Use 99357 in conjunction with 99356)

2 comments:

  1. Most developed in wealthy countries, where it has become a major channel of saving and investing.
    Health Insurance Australia

    ReplyDelete
  2. HOW WOULD YOU BILL 90837 WITH THE 99354 AND 99355 OUR PATIENT WAS SEEN FOR 3 HRS AND THEN FOR 4 HRS

    ReplyDelete

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