In the medical billing world, accurate coding plays a crucial role in ensuring proper reimbursement for the services provided. One of the often-overlooked areas in medical coding is the improving collections by using the right CPT codes for prolonged service. Prolonged service codes are essential for billing extended care beyond the typical time spent with a patient. Understanding and using these codes properly can significantly improve collections, reduce claim denials, and ensure that healthcare providers are compensated fairly for the additional time spent with patients.
In this blog post, we’ll delve into improving collections by using the right CPT codes for prolonged service, how they can improve collections, and why it’s vital to use them accurately. We’ll also include a testimonial from a satisfied client in Frankfort, Kentucky, who benefited from our medical billing services. Additionally, we’ll explore some specific CPT and ICD codes for prolonged services, ensuring you have the right tools to optimize your billing process.
What is Improving Collections by Using the Right CPT Codes for Prolonged Service?
Prolonged service CPT codes are used to bill for time spent with a patient beyond the standard office visit. These codes are essential when a healthcare provider spends extended time managing complex medical cases, discussing treatment plans, or conducting additional evaluations that go beyond typical service durations.
CPT code 99354 and CPT code 99358 are two of the most common codes used for billing prolonged services. Each of these codes has specific guidelines and requirements that must be followed to ensure accurate billing.
CPT Code 99354
CPT 99354 is used for prolonged office or outpatient services that go beyond the standard time for evaluation and management (E/M) services. This code applies when the time spent is at least 30 minutes longer than the typical office visit.
| CPT Code | Description |
| 99354 | Prolonged office visit lasting 30-74 minutes |
CPT Code 99358
CPT 99358 is applied to prolonged non-face-to-face services provided by a physician or other qualified healthcare professional. This could include activities like reviewing extensive medical records or preparing detailed reports after patient visits. This code applies when these non-face-to-face services last more than 30 minutes.
| CPT Code | Description |
| 99358 | Prolonged non-face-to-face services lasting 30 minutes or more |
Improving Collections by Using the Right CPT Codes for Prolonged Service
Properly billing for prolonged services compensates healthcare providers for the extra time and effort they invest in patient care. When healthcare providers use prolonged service CPT codes correctly, they significantly increase reimbursement rates for their medical practices.
Accurate Billing for Time Spent
By utilizing CPT 99354 for extended office visits or CPT 99358 for non-face-to-face services, healthcare providers can ensure they receive appropriate reimbursement for the additional time spent on patient care. This prevents underpayment and reduces the financial strain on the practice.
Reduced Claim Denials
Incorrect coding or failure to document prolonged services can lead to claim denials. By using the right codes and adhering to CPT code descriptions, practices reduce the chances of claims being rejected. This leads to faster payments and improved cash flow.
Enhanced Patient Satisfaction
Accurately documenting and billing for prolonged services can also lead to better patient satisfaction. Patients feel more cared for when they know their provider has taken extra time to address all their concerns. Proper billing ensures the practice can continue offering high-quality care without financial repercussions.
Example: Prolonged Services in Action
Let’s take a look at how these codes work in a real-life scenario. Imagine a patient visits their doctor for a regular check-up, but the appointment extends due to the need for a detailed discussion about a new treatment plan. You bill the standard visit using a regular CPT code, but because the visit lasted an additional 45 minutes, you should add CPT 99354 to the bill.
Similarly, after the appointment, the doctor spends another 40 minutes reviewing the patient’s medical history and preparing detailed notes. In this case, you should use CPT 99358 to capture the extra time spent on non-face-to-face work.
Table of Prolonged Service CPT Codes
Below is a summary of commonly used CPT codes for prolonged services:
| CPT Code | Description | Time Requirement |
| 99354 | Prolonged office or outpatient visit (face-to-face) | 30-74 minutes |
| 99355 | Each additional 30 minutes after the first 74 minutes | 30 minutes |
| 99358 | Prolonged non-face-to-face service | 30 minutes or more |
| 99359 | Each additional 30 minutes of non-face-to-face service | 30 minutes |
| 99357 | Prolonged inpatient or observation care (used after 99356 for additional time) | 30 minutes |
These prolonged services CPT codes reimburse the provider for the extra time spent with patients or on their care. CPT 99357 and CPT 99359 apply to extended time in inpatient settings and non-face-to-face services, respectively.
Documentation Requirements for Prolonged Services
Accurate documentation is critical when billing for prolonged services. For face-to-face services, the provider must document the total time spent with the patient, including the extended time that justifies the use of a prolonged service code. You must also document non-face-to-face services, such as reviewing patient records, in the patient’s medical record to support billing.
Proper documentation ensures compliance with payer requirements, reducing the risk of audits or claim rejections. Always include a detailed description of the services provided during the prolonged visit, and indicate the necessity for the extended time spent on patient care.
Prolonged Service CPT Codes for 2024
They update the CPT codes for prolonged services periodically to reflect changes in healthcare practices. As of 2024, CPT 99354 through CPT 99358 continue to be the primary codes for billing prolonged services. These codes apply across a variety of healthcare settings, including outpatient visits, inpatient care, and non-face-to-face services.
Be sure to stay updated on any changes in prolonged service CPT codes for 2024 by checking with official coding guidelines and your billing software provider.
Testimonial: Happy Client from Frankfort, Kentucky
“I’ve been working with Streamline Billing Group for over a year now, and they have truly transformed how we handle prolonged service billing. Before partnering with them, we were losing out on significant revenue due to coding errors and missed opportunities to bill for prolonged services. Streamline Billing Group has helped us identify the right CPT codes for extended visits and non-face-to-face work. I’m very satisfied with their services and would recommend them to any medical practice.” — Emily R., Frankfort, Kentucky
Why Use Streamline Billing Group for Your Medical Billing Services?
At Streamline Billing Group, we understand the complexities of medical billing, especially when it comes to prolonged service CPT codes. Our team of experts properly documents and bills every minute spent on patient care, improving collections and reducing claim denials. We specialize in using the right CPT codes for extended office visits, non-face-to-face services, and more, so your practice can thrive financially.
If you’re looking for the best medical billing services, contact us at Streamline Billing Group.
Conclusion
Using the right CPT codes for prolonged services is essential for accurate billing and improved collections. CPT 99354 and CPT 99358, among others, compensate healthcare providers for the extra time they spend with patients or reviewing their cases. By following best practices for documentation and code selection, medical practices can significantly increase their revenue and reduce the likelihood of claim denials.
If your practice is struggling with billing for prolonged services, Streamline Billing Group is here to help. Our expertise ensures we capture every extended visit or additional work in your billing process, so you never miss out on reimbursement. We believe that now you know about improving collections by using the right CPT codes for prolonged service.
For more information on our services, visit Streamline Billing Group and see how we can improve your collections today!
External References:
- American Medical Association – CPT Code Guidelines
- Centers for Medicare & Medicaid Services – Prolonged Services Coding
By accurately using prolonged services CPT codes, your practice can improve its financial health and ensure proper reimbursement for the time spent caring for your patients. Let us help you achieve that!