• How to Bill Prolonged Services


    Office-visit codes assume the service offered will take a set amount of time to perform. But sometimes an examination takes additional time based on the patient’s condition. Here’s how to correctly bill for a more extensive service.

     In addition to the appropriate level of E&M code for the visit, you will need to use one of the following CPT codes:

    • If the visit is less than 30 minutes, you do not need to report anything separately.
    • If 30-74 minutes, report 99354.
    • If 75-104 minutes, report 99354 and 99355.
    • If 105 minutes or more, report 99354, 99355 with 2 units or more for each additional 30 minutes.

    Example

    At 4:45 p.m. on Friday, your staff received a call about an established patient conveying all the signs and symptoms of an acute glaucoma attack. The patient’s daughter says she will bring her Medicare-aged Mom to the office now.

    After the visit, documentation supports a comprehensive history; a comprehensive exam and medical decision-making of high complexity. Serial tonometry was performed. The physician provided face-to-face care documented at 100 minutes.

    What CPT codes should you submit to insurance?

    • 99215 Established patient E&M level 5: You documented all components of the history, exam and medical decision making. Physician face-to-face time for this level of service is 40 minutes.
    • 99354 Prolonged E&M in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour: Submit this to account for the additional 60 minutes of time above the time associated with the exam.
    • 92100 Serial tonometry

    Additional Considerations

    • For inpatient prolonged services, see CPT codes 99356 and 99357 in your CPT 2017 book
    • Submit prolonged services with the appropriate level of E&M code. Prolonged services are not affiliated with Eye visit codes.
    • Only document physician face-to-face time, not total time in the office.