Re: how to document 99354?

[Guest guest]

To get paid for both codes, I might recommend that you chart everything for the physical in a separate part of the note than the office visit. But maybe someone who has been successful at getting both of these paid from the same visit will chime in. Don't forget your -25 modifier on the 99214.

Would a statement as the following be enough for medical record documentation for 99214 with 99354 or do I need to document the total direct contact time too?During this extended office visit, extra 31minutes of prolonged medical care provided in gathering the clinical information, doing the exam and review work up and management options.1. Hypertension...2. Diabetes...3. Hyperlipidemia...4. IBS....5. insomnia...Thank you very much.Helen

[Guest guest]

Beth,

I was thinking 99354 was a preventive, not the time add-on code...you are correct.  That's what happens when I reply at night from my phone!

 

and others interested in the coding aspects of medical billing,

 

Time only comes into play for the extended visit codes when you are billing the whole visit based on face to face time with the patient.  The 99354 is only applicable to time spent with the patient over and above that which was spent to perform the E & M portion of the visit.  If the total time spent is not at least 31 additional minutes then the 99354 is not able to be billed.  The 31 or more additional minutes is calculated by taking the average time for a level of E & M visit plus 31 minutes and this amount of time must be greater than or equal to the total amount of time spent with the patient.  A 99354 is billable for the first 31+ to 60 additional minutes spent with the patient.  If you spend more than 60 additional minutes with the patient then for each additional 30 minutes you would bill the E & M level plus a 99354 for the 1st 60 minutes and 1 unit of 9355 for each additional 30 minutes spent with the patient.  The total time spent face to face with the patient and the amount of time spent in counseling must be documented.  The topics counseled on and  the time devoted to each topic must be documented.  In the case of Medicare, separately identifiable counseling issues like smoking must be carved  out from the total time for the visit and in order to bill a 99354 the time spent in total less any time attributable to smoking cessation must be equal to the E & M average  time plus 31 or more minutes.

 

No 25 modifier is applicable to billing the 99354 & 99355 codes since these codes by definition are add-on codes. 

 

See http://www.cms.gov/transmittals/downloads/R1490CP.pdf  for an excellent explanation of the necessary documentation and how to calculate total time spent.

 

Dr. Beth Sullivan, DO

 

From: [mailto: ] On Behalf Of Pratt

Sent: Monday, March 21, 2011 10:29 PMTo: Subject: Re: how to document 99354?

 

 

To get paid for both codes, I might recommend that you chart everything for the physical in a separate part of the note than the office visit.  But maybe someone who has been successful at getting both of these paid from the same visit will chime in.  Don't forget your -25 modifier on the 99214.  

 

Would a statement as the following be enough for medical record documentation for 99214 with 99354 or do I need to document the total direct contact time too?During this extended office visit, extra 31minutes of prolonged medical care provided in gathering the clinical information, doing the exam and review work up and management options.

1. Hypertension...2. Diabetes...3. Hyperlipidemia...4. IBS....5. insomnia...Thank you very much.Helen

[Guest guest]

I try code mostly 99214, very occasional 215. I do code and get paid for

a 9938/9--- and 9921-- with 25 modifyer. I find that the 9921- fee is

often discounted. But still, I do get

paid more by adding this with the -25 than I would if I don't code that

at all. Some insurances will pay for these two together, some won't. I

have never done an extended visit code.

A pt would have to be really, really sick, it would seem to warrant

that. 99215 +/- -25 should cover most visits.

> In California where I have I think only been reimbursed once ever for

> an office visit with a PE, we code the office visit to the highest

> level of specificity. We are not afraid to code a 99215 if the visit

> and note support it.

>

>

>

> On Mar 23, 2011, at 5:16 AM, Myria <myriaemeny@...

> > wrote:

>

>> I routinely get paid for the 99214 (E & M) and the 9938_ or 9939_ (PE

>> new or established) when adding modifyer -25 to the 99214. But I have

>> only gotten paid once for the extended visit code in almost 3 years.

>> I've given up on using it. I continue to document the total time with

>> patient.

>>

>> ------------------------------------------------------------------------

>> *From:* Pratt <kpratt.1022@...

>> >

>> *To:* "

>> <mailto: > "

>> <

>> <mailto: >>

>> *Sent:* Mon, March 21, 2011 10:28:59 PM

>> *Subject:* Re: how to document 99354?

>>

>> To get paid for both codes, I might recommend that you chart

>> everything for the physical in a separate part of the note than the

>> office visit. But maybe someone who has been successful at getting

>> both of these paid from the same visit will chime in. Don't forget

>> your -25 modifier on the 99214.

>>

>>

>>

>> On Mar 21, 2011, at 1:52 PM, Helen Yang <helenwyang@...

>> > wrote:

>>

>>> Would a statement as the following be enough for medical record

>>> documentation for 99214 with 99354 or do I need to document the

>>> total direct contact time too?

>>>

>>>

>>> During this extended office visit, extra 31minutes of prolonged

>>> medical care provided in gathering the clinical information, doing

>>> the exam and review work up and management options.

>>>

>>> 1. Hypertension...

>>> 2. Diabetes...

>>> 3. Hyperlipidemia...

>>> 4. IBS....

>>> 5. insomnia...

>>>

>>>

>>> Thank you very much.

>>>

>>> Helen

>>>

>>

>

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[Guest guest]

I try code mostly 99214, very occasional 215. I do code and get paid for

a 9938/9--- and 9921-- with 25 modifyer. I find that the 9921- fee is

often discounted. But still, I do get

paid more by adding this with the -25 than I would if I don't code that

at all. Some insurances will pay for these two together, some won't. I

have never done an extended visit code.

A pt would have to be really, really sick, it would seem to warrant

that. 99215 +/- -25 should cover most visits.

> In California where I have I think only been reimbursed once ever for

> an office visit with a PE, we code the office visit to the highest

> level of specificity. We are not afraid to code a 99215 if the visit

> and note support it.

>

>

>

> On Mar 23, 2011, at 5:16 AM, Myria <myriaemeny@...

> > wrote:

>

>> I routinely get paid for the 99214 (E & M) and the 9938_ or 9939_ (PE

>> new or established) when adding modifyer -25 to the 99214. But I have

>> only gotten paid once for the extended visit code in almost 3 years.

>> I've given up on using it. I continue to document the total time with

>> patient.

>>

>> ------------------------------------------------------------------------

>> *From:* Pratt <kpratt.1022@...

>> >

>> *To:* "

>> <mailto: > "

>> <

>> <mailto: >>

>> *Sent:* Mon, March 21, 2011 10:28:59 PM

>> *Subject:* Re: how to document 99354?

>>

>> To get paid for both codes, I might recommend that you chart

>> everything for the physical in a separate part of the note than the

>> office visit. But maybe someone who has been successful at getting

>> both of these paid from the same visit will chime in. Don't forget

>> your -25 modifier on the 99214.

>>

>>

>>

>> On Mar 21, 2011, at 1:52 PM, Helen Yang <helenwyang@...

>> > wrote:

>>

>>> Would a statement as the following be enough for medical record

>>> documentation for 99214 with 99354 or do I need to document the

>>> total direct contact time too?

>>>

>>>

>>> During this extended office visit, extra 31minutes of prolonged

>>> medical care provided in gathering the clinical information, doing

>>> the exam and review work up and management options.

>>>

>>> 1. Hypertension...

>>> 2. Diabetes...

>>> 3. Hyperlipidemia...

>>> 4. IBS....

>>> 5. insomnia...

>>>

>>>

>>> Thank you very much.

>>>

>>> Helen

>>>

>>

>

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