Author Topic: Re: billing 99354  (Read 5649 times)

best biller

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Re: billing 99354
« Reply #15 on: March 20, 2014, 07:32:12 PM »
thanks to everyone!
firstly i received the eob from the patient and secondly i tried billing without a modifier and was denied for incorrect modifier

best biller

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Re: billing 99354
« Reply #16 on: March 25, 2014, 01:41:40 PM »
any suggestions???????????????

PMRNC

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Re: billing 99354
« Reply #17 on: March 25, 2014, 03:32:32 PM »
Which line was being denied for incorrect modifier ?   99214 or 99354?
Could your problem be in the "units"?   this may help:    http://ecpmd.com/files/CPT99354_99357.pdf
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

best biller

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Re: billing 99354
« Reply #18 on: September 10, 2014, 11:57:04 AM »
I work in a internal med office and the physician usually bill a 99214 but the time she spend with the patient may be 40-60min and she also may give a b-12 injection, so i add a prlong code 99354 but it is being rejected by the insurance carrier. i usually code it like this:
99214-25
99354
96372-59
J3420

everything is being paid except for the prolong code. am i coding this wrong or missing a modifier, can anyone help?

kristin

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Re: billing 99354
« Reply #19 on: September 10, 2014, 07:26:02 PM »
Well, for starters, my understanding is you can't bill the 99354 until you reach a total of 55 minutes for the 99214 visit. That is because you can't count the 25 minutes for the 99214 towards your time, only what comes after, and it has to be face to face from the provider. A patient sitting in a room alone, or seeing someone during the visit other than the provider doesn't count towards the time. So a 40 minute visit won't qualify for the 99354, at all.

Next, different payers have medical policies and coding policies in place for these prolonged visit codes. Have you contacted the insurance companies that are denying your claims, or researched their websites for info on what they require for billing these codes?