Wiki time based + prolonged service

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Kiracodes

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I have a couple Neurohospitalists. After talking to them and hearing the amount of time they are putting into their patients, I am wondering if Time based coding would be a better option for them. They do a lot of counseling and coordination of care due to being hospital providers and they can show their documentation for that. The only hiccup would be that they are always the consulting MDs and we follow Medicare coding guidelines for all payers so we don't use consult codes. That limits us to Subsequent inpatient codes (99231-99233) and outpatient visit codes (99202-99215) with which it's incredibly difficult to capture the total time for some of their visits.

Can we add on an apprpriate prolonged service code, if so what are the documentation requirements that need to be shown?
 
If you read prolonged service codes I do believe they give examples on how to use them. If it's less than the minimum for the prolonged service code then it's E&M otherwise ... That's an example.
 
Prolonged Services

Re usage of Prolonged-from the guidelines In those E/M services in which the code level is selected based on time, prolonged servces may only be reported wth the highest code level in that family of codes as the companion code.
In other words, you cannot bill a low level visit and tack on a prolonged service.
Also very important to state the total duration time of the visit and that it is face-to-face. This is important because in instances when more than one encounter occurs in a single day the providers from a group can combine their services.
Tricia D
 
dtricia said:
Re usage of Prolonged-from the guidelines In those E/M services in which the code level is selected based on time, prolonged servces may only be reported wth the highest code level in that family of codes as the companion code.
In other words, you cannot bill a low level visit and tack on a prolonged service.
Also very important to state the total duration time of the visit and that it is face-to-face. This is important because in instances when more than one encounter occurs in a single day the providers from a group can combine their services.
Tricia D
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That is not true. The prolonged timed codes 99354-99357 can be applied with any level of service. Look at the listing in the book, it details which codes they may be appended to. It has no restriction for the highest level only. I have used these successfully with a 99213 in the office setting as well as the 99221 in the inpatient setting. In addition the prolonged codes for inpatient 99356-99357 include floor time as well as face to face patient time. The floor time must be time spent on the unit discussing that patient with staff or other physicians or reviewing test results, as long as it is pertaining to only that patient.
 
I am referring to prolonged service based on time only. That is waht I said. I am not wrong.
See section H of the guidelines.
Tricia D
 
Prolonged service is based on time only. I am not sure what you are referencing. Section H of which guidelines? The 99354-99357 codes are appended to other visit levels when the time spent with the patient exceeds the time allotted for that visit level by a minimum of 30 minutes. So they are time based but not restricted to the highest level in one area. Please show me where you are seeing a section H of guidelines that addresses this.
 
H. Prolonged Services Associated With Evaluation and Management Services Based
on Counseling and/or Coordination of Care (Time-Based)
When an evaluation and management service is dominated by counseling and/or
coordination of care (the counseling and/or coordination of care represents more than
50% of the total time with the patient) in a face-to-face encounter between the physician
or qualified NPP and the patient in the office/clinic or the floor time (in the scenario of
an inpatient service), then the evaluation and management code is selected based on the
typical/average time associated with the code levels. The time approximation must meet
or exceed the specific CPT code billed (determined by the typical/average time
associated with the evaluation and management code) and should not be ?rounded? to
the next higher level.
In those evaluation and management services in which the code level is selected based on
time, prolonged services may only be reported with the highest code level in that family
of codes as the companion code.

CMS MANUAL, CHANGE REQ 5972 , TRANSMITTAL 1490 SECTION 30.6.15.1
 
I misunderstood your response then, I understood you to say that prolonged timed codes can only be used with highest level of service which is incorrect. If the visit is only counseling then I agree with what is stated in this transmittal.
 
I read the CPT Guidelines a couple times and it does not state that there needs to be counseling and coordination or care but the IOM does? In fact the CPT guidelines state that they can be reported in addition to the designated E/M services at any level. So are they both correct? My docs do about half and half. But with the elimination of the consult codes they are being thrown into the outpatient codes 99202-99215 and inpatient codes 99231-99232 and when they flip to time based they miss out on A LOT. Yes they use the initial inpatient when they can but only our JMAC will accept it.
 
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