We have previously discussed using prolonged visit code CPT 99354 for prolonged patient visits. Today we will be discussing another CPT code that will help you capture revenue for the time you spend taking care of seriously ill patients in your office. That code is CPT code 99355.
CPT 99355 can be used when you are spending more than the standard amount of time you would normally spend with a patient. For each additional 30 minutes of face-to-face time spent with a patient, you can bill code CPT 99355. You will, however, need to list this code separately in addition to the code used for the prolonged physician service.
Many physicians do not use CPT code 99355. If, however, you are spending the extra time caring for a patient you do deserve to be compensated for your services. Just make sure that you document your time properly and provide the necessary Medical Necessity components when using the code.
According to the Medicare Manual, you must document the date and the start and end times of the time you spend with a patient. Only the time you spend with the patient counts. The time your staff spends with a patient cannot be billed with code CPT 99355.
The amount of time you can receive by billing with CPT 99355 will vary depending on the region of your practice. The average reimbursement amount for this code is in the range of $95.00.
Understanding Your Options
If you are caring for a seriously ill patient, you deserve to be paid for the extra time spent with that patient. For example, if you are treating the patient in your office and are spending a significant amount of time with the patient deciding what the best course of care will be, you have a few options for capturing this time.
If you spend more than 40 minutes with this patient and the visit meets all of the criteria, you can bill for a 99215 visit. If, however, you spend another half an hour with the patient above and beyond that 40 minutes, you can bill with CPT code 99354. Additional half hour increments can be billed using CPT code 99355.
An Uncommon Occurrence
It is not common for physicians to spend more than two hours with a patient, but it does happen on occasion. When it does, you deserve to be compensated for this time. This is why it is important to understand CPT code 99355.
Documentation is Key
While CPT code 99355 can help you capture the revenue that would otherwise be lost when spending extra time with patients, you must document your patient visits properly. This means recording the start and end time of the patient's visit as well as any face-to-face time spent with that patient.
Let's say, for example, that a patient comes into your office with a flare-up of COPD. You may start the patient with an oxygen treatment in your office while performing your physical and medical decision making and your medical history documentation. You are also spending time reviewing medical records and deciding the proper course of treatment. Let's say you then decide that your patient needs a nebulizer treatment and you leave the room to see another patient. You need to document the time you spend with that patient up until the point you leave the room. The clock stops once you are no longer in front of the patient. Once you return to the room with the patient, the clock starts again.
For all of the extra time you spend with a patient, you can continue to accrue time towards CPT code 99354. If additional time is spent above and beyond that code, you can accrue time towards CPT 99355.
Time is Money
With today's economic struggles and financial cut-backs, proper billing can make or break the financial well-being of a medical practice. Because of this, you need to ensure that you are capturing as much revenue as possible for your medical practice. If you are providing a patient with extensive care, you deserve to be compensated for the time spent. You owe it to yourself and your practice to maximize your revenue, and that means billing with code CPT 99355 when the situation warrants it.
Just how much of a difference can CPT code 99355 make? Let's say you only billed using code CPT99214 for a visit with a seriously ill patient. You would generate approximately $90.00 for 135 minutes of your time spent. If, however, you spend 135 minutes with a patient and bill using code CPT 99215, CPT 99354 and CPT 99355, you would be able to generate $120 plus $95 and an additional $95 for a total of $310. That is more than three times the revenue you would have generated using the lower CPT code. You owe it to yourself and your practice to use these codes whenever possible and maximize the revenue brought into your practice.
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