Most practices are either unaware of these codes or are uncomfortable using these codes because they are not certain how or in which circumstances they apply.
An example might be where you have provided a level 3 service involving a patient with a newly diagnosed condition that may be detrimental to their health in the long run. Once diagnosed and appropriate tests are done, the time spent with the patient explaining alternatives, results, and advising them of their care etc., and with the patient asking many questions and having concerns, a great amount of time has gone by.
If you select a level 3 evaluation management code (99213), typically this code would allow you 15 minutes face to face with the patient. But in this instance you spent 45 minutes total face to face with this patient. You could bring your level 3 to a level 4 or a level 5, however, the necessity of the level selected may not be there nor appropriate. In this case, you can use the 99354 prolonged service code with total duration of (30-74 minutes), if time spend face to face is accurately documented with medical necessity for the additional time.
The main reason physicians fail to capture this additional revenue for their practices is failure of proper documentation. Remember, that in the event of an audit documentation is always king in the medical practice!! With that will come cash flow.
Let us help you maximize your revenue and grow your practice. We have a billing solution for your unique practice needs. Let us design a cost effective solution for your medical practice!! Contact us at 1.877.666.5279