Use Updated Prolonged Services E/Ms to Capture Psychotherapy

Posted on 6 Nov, 2015 |comments_icon 4|By Chris Boucher

Get more specific with new versions of these standard E/M codes.

When the 2016 CPT® coding books come out, you’ll have a revised set of E/M codes that should make coding for prolonged services that include psychotherapy a lot easier.

It’s good to see that CPT® is including psychotherapy in the prolonged services code set,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa.

Read on to check out what the revised codes will look like, and get some expert input on when to use them.

CPT® Adds Psychotherapy to Prolonged Services Codes 99354, 99355

CPT® 2016 will include updates to the following codes (emphasis added to show the revisions):

  • 99354 — Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service)
  • 99355 — … each additional 30 minutes (List separately in addition to code for prolonged service).

See also: Learn New Prolonged Services Codes to Master ‘Team’ Coding

Psychotherapy Can Push E/Ms Past Standard Time Limit

According to Hauptman, these codes will only help you capture the pay you deserve when you are coding for prolonged services that involve psychotherapy. “This type of care, inherently, requires time — and often more time than was reportable prior to this [code] change,” she says.

“Also further clarifying when to use the code — ‘beyond the typical service time of the primary procedure’ — illustrates that it could be added on to any service level; not just the highest,” Hauptman says.

Advice: As with any revised or new codes, keep your ear to the ground about 99354/99355. Check in chat rooms, and with your local coding community experts, to see who’s using the code and how payers are receiving it.

And, of course, check Medicare transmittals regularly. “We’ll have to see how CMS develops policy around these clarifications,” Hauptman says.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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