How to correctly bill for prolonged service codes

Why This Topic Matters

Accurate prolonged service reporting can affect claim payment, denial risk, and documentation quality. The article is relevant to anyone reviewing time-based E/M billing and Medicare documentation expectations.

Article Sections

1. Billing prolonged service codes with office E/M services

   Introduces prolonged service billing in the office setting and discusses the relationship between extra time, E/M services, and Medicare payment considerations.

2. Documentation and time-counting considerations

   Covers general documentation concerns, how time is discussed in the medical record, and the importance of separating covered time from other billable services.

3. Examples and reviewer expectations

   Summarizes practical examples and describes the kinds of documentation reviewers may expect to see when prolonged service reporting is supported.

4. Using prolonged services codes instead of a modifier

   Addresses the comparison between prolonged service reporting and a modifier-based approach, along with related payer considerations.

5. A guide to using prolonged services codes 99354 and 99355

   Presents a reference table showing how prolonged service reporting relates to common office E/M code levels and total time bands.