Cardiology Coding Alert

Document time — and the reason for the time — to support reporting these codes.

CPT® offers a way to report extra time providers spend on an E/M service. If your patient’s payer is one that agrees that time is money, use these two tips to guide reporting face-to-face office/outpatient prolonged service codes +99354-+99355.

The codes: You’ll use the following pair of E/M prolonged service codes on claims to report face-to-face (F2F) time your provider spends with a patient on a single date of service:

• +99354, Prolonged service 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 service)
• +99355, … each additional 30 minutes (List separately in addition to code for prolonged service).

Tip #1: Know How to Count Minutes

You report prolonged service codes in addition to E/M codes that have a typical or specified time in the code descriptor. The +99354 descriptor indicates it’s for the first hour of prolonged services, but as is so often the case with code descriptors, you can’t take the descriptor at face value. 

Halfway rule: Do not report +99354 “for anything under 30 minutes (above the average time of the normal service),” says Jacqueline Mehalich, RN, CPC, CPC-H, manager of physician education at Allegheny Health Network in Pittsburgh, Pa.

In addition, you would not report the add-on code for an additional 30 minutes (+99355) “for anything that does not extend past the next 15 minutes,” Mehalich says.

Takeaway pointers: The time involved with either code does not have to be consecutive, but it does have to be on the same day. You should use +99354 only once per date, even if the time the physician or other qualified health care professional spends is not continuous on that date. Use +99355 to report each additional 30 minutes beyond the first hour, depending on the place of service. As explained and shown in the table, you also may use this code to report the final additional 15-30 minutes of prolonged service on a given date.

Tip #2: Ensure Documentation Supports Extra Minutes

“The note should clearly reflect information explaining why the service was extended,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa.

For example, in the case of a congestive heart failure case involving a newborn with Down syndrome and a ventricular septal defect, “the patient’s co-morbid conditions and the medical history should be noted to justify the additional code for the additional decision making needed,” Hauptman says.

Bonus Tip: Watch for Changes in CPT® 2016

The almost final, preproduction file of CPT® 2016 shows changes to codes for prolonged services.

Codes +99354 and +99355 add references to psychotherapy services (changes underlined):

• +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).

The file indicates you’re also likely to see new codes for prolonged clinical staff services:

• +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)
• +99416, … each additional 30 minutes (List separately in addition to code for prolonged service).