tci Part B Insider - 2011 Issue 14

Reader Questions: Does One-Hour E/M Warrant Add-on Prolonged Service Code?

Question: Our physician provided a one hour E/M service, most of which was spent on counseling, so we reported 99215 and one unit of +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour). An outside auditor came to our practice and said we should not have reported 99354, and told us to write our payer and give back the reimbursement we received for this extra charge. Is this accurate?Answer: Your auditor is correct. You can only add +99354 if your physician spent an additional 30...

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