Inpatient Facility Coding & Compliance Alert

Question: Our psychiatrist recently performed an extended psychotherapy session for a patient. The session lasted about 100 minutes in length. Can I use the prolonged services code, +99354 along with the psychotherapy code to cover for the extra time spent during the session? No other service was provided.

Nebraska Subscriber

Answer: You can use a prolonged service code with a psychotherapy code when the session extends beyond 90 minutes or more. Although psychotherapy codes are no longer location specific, you still have to choose an appropriate prolonged services code depending on the location in which the clinician provides the therapy.

So, if the provider performs the psychotherapy in his office, choose +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]) as an add-on code to the psychotherapy code 90837 (Psychotherapy, 60 minutes with patient and/or family member).

If the service occurs in an inpatient setting, use +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]).

Even though the descriptor to prolonged services codes mention that these codes are add-on codes for E/M codes, the guidelines for 90837 mention that appropriate prolonged services codes can be used with this psychotherapy code for sessions lasting for a duration of 90 minutes or more face-to-face with the patient.