Can prolonged services be added to preventive medicine codes?

March 9th, 2009 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)   Preventive Medicine Service  
0 Votes - Sign in to vote or comment.

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.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
November 18th, 2020 - Raquel Shumway
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
Cross-A-Code Instructions in Find-A-Code
November 18th, 2020 - Raquel Shumway
Cross-A-Codeis a toll found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
COVID Vaccine Codes Announced
November 11th, 2020 - Wyn Staheli, Director of Research
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Are You Aware of the 2021 Star Rating System Updates?
November 5th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:  Quality of ...
Special Needs Plans Help Beneficiaries and Risk Adjustment Reporting
October 22nd, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...
CMS Expands Telehealth Again
October 20th, 2020 - Wyn Staheli, Director of Research
On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.
Significant COVID-19 Code Changes as of October 6
October 8th, 2020 - Wyn Staheli, Director of Research
Significan COVID-19 Code Changes as of October 6



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association