• Billing based on exam time


    I have several patients with Parkinson's disease/diplopia. I'm trying different powers of Fresnel prisms to try to reduce their diplopia. The exams sometimes take over an hour. How can I bill these visits since the extended exam code, 99354, is no longer allowed? Can I bill the cost of the prisms?

    With the change in E/M documentation requirements effective Jan 1, 2021, these visits can be billed based on medical decision-making or physician time on the day of the encounter. When billing based on time, be sure to document well how physician time was spent on the day of the encounter.

    For new patients:
    • 99204: 45 - 59 minutes
    • 99205: 60 - 74 minutes
    For established patients:
    • 99214: 30 - 39 minutes
    • 99215: 40 - 54 minutes
    For services 55 minutes or longer, you can report prolonged service code 99417. 

    A high volume of level 5 plus prolonged services will guarantee a request for records in an audit. In addition to the ophthalmic-related ICD-10 code, be sure report the systemic ICD-10 as well, such as Parkinson’s disease.