Cardiology Coding Alert

Hint: The importance of time is vital when reporting prolonged services.

Do you know your options when your cardiologist handles complex patient conditions, counseling, research, and record reviews that extend care beyond the typical minutes outlined in evaluation and management (E/M) codes 99201-99215?

If you want to protect your reimbursement, you cannot neglect the prolonged services codes. Test your coding skills so you can submit clean claims every time.

Focus on These Codes for Direct Patient Contact

Question 1:  What codes can you consider when the cardiologist provides prolonged service(s) with direct patient contact for a patient beyond the usual E/M service time?

Answer 1: For prolonged services with direct patient contact, look to the following codes for the office or other outpatient setting:

• +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).

“Codes +99354 and +99355 are used only in the outpatient setting but apply to a regular E/M service when a patient presents with a problem or when the prolonged service is required during a psychotherapy session,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

On the other hand, +99356 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service)) and +99357 (… each additional 30 minutes (List separately in addition to code for prolonged service)) only apply to situations where the patient has been admitted to the hospital or has been admitted to observation status, Witt adds.

Don’t miss: With +99356 and +99357, the prolonged service time is based on unit/floor time devoted to the care of the inpatient.

Use 99358 and +99359 for Prolonged Services Without Direct Patient Contact

Question 2: What codes can you consider when your cardiologist provides prolonged service(s) without direct patient contact for a patient beyond the usual E/M service time?

Answer 2:  When the physician provides a prolonged service that is considered neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of the E/M service, you can look to the following codes:

• 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour)
• +99359 (… each additional 30 minutes (List separately in addition to code for prolonged service)).

Don’t miss: CPT^® guidelines are very strict when reporting these codes. Most important, they must “relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management.”

CPT^® also stresses that you cannot use the codes for “time spent in care plan oversight services ... home and outpatient INR monitoring ... medical team conferences ... on-line medical evaluations ... or other non-face-to-face services that have more specific codes and no upper time limit.”

So, according to Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, per the Centers for Medicare & Medicaid Services (CMS), you can report 99358/+99359 providing you can document “prolonged communication consulting with other health care professionals related to ongoing management of the patient and prolonged review of extensive health records and diagnostic tests regarding the patient.” You must also document the additional 30-74 minutes for 99358 and 15-44 minutes for +99359. The same rules as +99354-+99355 apply, only you don’t have to substantiate direct patient contact.

Understand Importance of Time and Prolonged Services

Question 3: What is the importance of time when it comes to reporting the prolonged services codes?

Answer 3: Time is a key factor in determining whether to use a prolonged service code. CPT^® regulations clearly state that “prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management codes.”

Turn to +99354 or +99356 to report the first hour of prolonged service on a given date, dependent upon the place of service (POS). You can also use 99358 to report the first hour of prolonged service on a given date, but its use is not dependent upon the POS. You should use all three codes only once per day.

Look to +99355 or +99357 to report each additional 30 minutes beyond the first hour, dependent upon the POS. You can also use +99359 to report each additional 30 minutes beyond the first hour, but its use is not dependent on the POS. You may use all three codes to report the final 15-30 minutes of the prolonged service on a given day. You cannot separately report a prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes.

Coding tip: “When reporting prolonged services, time needs to be precise. Documentation should detail important clinical matters,” Falbo says. “And it should also support coding.”