Cardiology Coding Alert

Clinical staff service add-on codes present new possibilities.

CPT^® 2016 both adds new codes and revises existing ones for reporting the extra time your cardiologists and clinical staff members spend with patients.

Keep +99415 and +99416 in Mind for Clinical Staff

CPT^® 2016 will add two add-on E/M codes to help you capture work your clinical staff performs after your physician sees the patient for an E/M service. You will be able to report +99415 (Prolonged clinical staff service [the service beyond the typical service time] during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour [List separately in addition to code for outpatient Evaluation and Management service]) and +99416 (… each additional 30 minutes [List separately in addition to code for prolonged services]) to seek additional, deserved reimbursement.

“Now here is a set of codes to really sink your teeth into; we hope!” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa. “Often times a physician’s time with the patient only paints a partial picture of what occurred during the visit. It could have been that the staff was asked to give an injection, but the patient was uncooperative. It might include education for a new medication, therapy, or options for care that go far beyond the time illustrated in the E/M code, but, that education doesn’t have to be that of the physician. The staff [members] in a physician’s office are important to the care of the patient and also are an expense to the physician. These codes make good sense all around to be included in the new code sets. This may also come into play with the trend of coverage for more preventive services. I am anxious to see how these codes play out in policy and, if reimbursable, what might that reimbursement look like.”

Reminder: Documentation must include time specifics to capture prolonged service codes or have a sentence that states additional total time and the purpose. For instance, documentation may note an additional 22 minutes spent face to face with the patient discussing a topic that the documentation specifies.

Add ‘Beyond the Typical Time’ to 99354 and 99355

New codes aren’t the only E/M change you’ll need to watch out for in 2016. CPT^® 2016 updates two existing prolonged services codes as follows (underline 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).

“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. We’ll have to see how CMS develops policy around these clarifications,” Hauptman says.