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May 2009
Vol. 19 No. 5
Practice Management
ID Physicians Are Underutilizing Prolonged Service Codes

In these lean economic times, it is imperative that ID physicians get paid for their work. But the 2007 Medicare Utilization data (log-in required) reveal that ID physicians continue to underutilize a valuable billing opportunity: Prolonged Service Codes (99354-99357).  These codes are time-based codes that can be billed in the inpatient or outpatient setting when you are engaged in additional face-to-face time with patients that goes beyond the usual Evaluation and Management (E&M) service codes.

You can use CPT code 99356 to report prolonged services with hospitalized patients who require an additional 30 to 74 minutes of face-to-face time (or floor/unit) time.  To report each additional 30 minutes of inpatient prolonged service time, CPT code 99357 should be used.  Use codes 99354-99355 to report prolonged services in the outpatient setting.  Prolonged service codes should only be billed once per patient per day and should reflect the total amount of additional time spent with a patient on that day.  Because prolonged services are add-on codes, modifiers are not needed.   

For more information about billing and coding, visit
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