Medical Billing Forum
Coding => Coding => : dawn May 26, 2008, 11:56:25 AM
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how do you bill for a prolonged preventive medicine well care visit? the prolonged visit code 99358 denies against a 99381, if I added a modifier would it get paid? or increase the reimbersment? this is for a well care visit with an established patient (so no sick code is billed) but the Doctor had to spend extra time with the patient (usually mom and dad) to explain plan of treatment for autisim or developmental delay ect.
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Hi,
I am not familiar with prolonged well care visits, but I did a little research. The 99058 is to indicate that services were provided on an emergency basis. I can't think of too many situations that a well care visit would be done on an emergency basis so I don't think there is any modifier you can add that will result in payment of both codes billed together.
I am not aware of any code that indicates prolonged well care. If anyone else is familiar with this, please let us know. :)
Thanks
Michele
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Did the visit substantiate to bill the well visit with an o/v code (99213, etc)? Are there any dx codes to bill with the v-code?
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Actually, there are a section of codes 99354 - 99357. However, the prolonged visit codes can NOT be willed with a well visit. See definition of these codes below. If the provider spent the additional time with the parents discussing autism or a developmental issue, you could use a secondary dx code of: V65.49 health (advice) (education) (instruction) NEC or Child behavior causing concern V61.20. Bill your well care with a secondary ofc visit 99213-25 if the visit went beyond the average time of the 99213 then also add a 99354. I would only bill this way if you have the appropriate documentation from the provider. More than likely, the insurance will request med rec. I never have a hard time getting the 99354 to pay. I use it most for regular ofc visits 99203-99205 and 99213-99215 when the visit includes counseling. Also, if there was a dx made for dev delay or autisim code your seconday ofc visit with that dx. There are several different ways to go about it. If you have an example with the dx codes, I would be more than happy to help you code. We also use the 99354 when someone from our office has to translate, usually spanish or sign language, for the pt to the dr, as this takes a lot more time than an average office visit. Hope this was helpful!
"Prolonged physician services (CPT code 99354) in the office or other outpatient setting
with direct face-to-face patient contact which require one hour beyond the usual service
are payable when billed on the same day by the same physician or qualified nonphysician
practitioner (NPP) as the companion evaluation and management codes. The time for
usual service refers to the typical/average time units associated with the companion
evaluation and management service as noted in the CPT code. Each additional 30
minutes of direct face-to-face patient contact following the first hour of prolonged
services may be reported by CPT code 99355.
Prolonged physician services (code 99356) in the inpatient setting, with direct face-toface
patient contact which require one hour beyond the usual service are payable when
they are billed on the same day by the same physician or qualified NPP as the companion
evaluation and management codes. Each additional 30 minutes of direct face-to-face
patient contact following the first hour of prolonged services may be reported by CPT
code 99357.
Prolonged service of less than 30 minutes total duration on a given date is not separately
reported because the work involved is included in the total work of the evaluation and
management codes.
Code 99355 or 99357 may be used to report each additional 30 minutes beyond the first
hour of prolonged services, based on the place of service. These codes may be used to
report the final 15 – 30 minutes of prolonged service on a given date, if not otherwise
billed. Prolonged service of less than 15 minutes beyond the first hour or less than 15
minutes beyond the final 30 minutes is not reported separately."
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After all these years of billing....I stumbled upon modifier 21....prolonged evaluation and management services. Add that yo your E/M code next time and let us all know if you get paid.
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Thanks jns85008. I wasn't thinking of the well visit codes as part of the E&M's and I skipped right over the 21 modifier. That may just work. Let us know if you give it a try.
Michele
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