Prolonged services 99356

[jdibble]

I have a question about the use of the Prolonged Services codes if someone could help...

One of my Hospitalists is billing for a 99356 and the billing company sent back an inquiry stating that the insurance denied the charge because there is no "sub care" billed. I looked into the notes, and apparently the patient was seen early in the morning and admitted by another Hospitalist and then this physician saw the patient for continued care later that morning. The admit doc billed 99222 and then the second doc billed for the prolonged charge both under the same tax ID.

My question is, to bill for the prolonged services would both visits have to be done by the same physician or could it be another doc from the same group? Hopefully someone can clear up this confusion for me - I will be meeting with the Hospitalists tomorrow and I would like to have this issue presented to them so they know how to apply this charge in the future.

Thanks for the help.

[mitchellde]

99356 is an add on code and it must be billed on the same 1500. I am not certain regarding same doctor, but you will have to bill one 1500 with the 99222 then the 99356 and use each doctors rendering NPI in 24J. So unless someone can come up with contrary information regarding the use of 2 doctors then that is how I would do it.

[bfontes]

Per medicare guidelines, prolonged services using codes such as 99356 are payable when billed on the same day by the same physician.

Hope this helps

[jdibble]

Yes that does help - Thank you both!