Can prolonged services be added to preventive medicine codes?

March 9th, 2009 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)   Preventive Medicine Service  
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There are two sets of prolonged services codes, one set for face-to-face additional time spent with the patient in the office or hospital, and one set for non-face-to-face time.  Non-face-to-face time is typically not paid by most insurers. In 2009, CPT® changes its description of these services, but CMS did not.  There are detailed articles in Codapedia about this topic.

The prolonged services face-to-face codes are add on codes. They may not be reported alone.  They may only be reported with the CPT® codes listed in the description of these codes in the CPT® book.  The office and outpatient prolonged services codes, which are 99354 and 99355, may only be used in conjuction with 99201-99215, 99241-99245, 99324-99337, 99341-99350, 90809, 90815, and not with any other codes.

These do not include the preventive medicine services. Preventive medicine services are not time based, and the prolonged services codes may not be used in addition to them. 

Clinicians often ask what they can bill if a preventive medicine service is mostly based on counseling.  The preventive medicine service definition includes (in addition to an age/gender appropriate history and exam) anticipatory guidance and risk factor reduction.  There is no additional reimbursement for counseling at a preventive medicine visit.

If an additional problem is addressed, it is possible to bill an office visit along with the preventive medicine service, according to CPT®.  See the article in Codapedia about that topic.   Some clinicians ask the patient to schedule an additional appointment to return to talk about other problems, and some prefer not to do this.

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