Q: I spent about one hour and ten minutes on an evaluation with a patient, should I bill a higher E&M code to account for my time?

A: Typically not, the major reasons to bill a higher level E&M code is the level of service for history, medical decision making and level of examination. If you fit these criteria you may bill a higher level E&M code. But bear in mind that there are prolonged service codes that allow you to bill for additional evaluation and management time when the other factors are not of an increased level. These codes are 99354 and 99355. 99354 is used when you spend at least 30 minutes beyond the time allowed for the appropriate E&M code time. If you spend more than one hour and 14 minutes beyond the code you can additionally bill a 99355. These codes are also valid in California Workers Compensation and are valued at $180.20 and $90.10 respectively.


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