Neurology & Pain Management Coding Alert

If the neurologist provides an extended E/M visit, you may be tempted to report prolonged services (99354). But unless he or she spends at least 30 minutes beyond the CPT reference time for the E/M level you choose, you'll be overbilling if you choose 99354-99357. Maintain a '30 Minutes Over' Minimum Prolonged services are a valuable reimbursement tool, but they require that you track carefully the total face-to-face time the neurologist spends with the patient.
 
To use +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]) or +99356 (Prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring for high-risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient]; first hour [list separately in addition to code for inpatient evaluation and management service]) the physician must provide a minimum of a half-hour of face-to-face time with the patient in addition to the time that CPT allots for the E/M service you claim. The time need not be continuous, says Jaime Darling, CPC, certified coder for a nine-physician practice in Escondido, Calif., but it must occur on the same date of service.
 
For example, an established patient arrives unscheduled at the neurologist's office. The patient's daughter has brought him because he became disoriented and began slurring his speech while the two of them shopped at a nearby grocery store, and she's worried that her father is suffering a stroke. The neurologist takes the emergency appointment and spends 30 minutes evaluating the patient. Confident that the patient is not in immediate danger, the neurologist leaves the room to attend to another patient. He later returns and spends an additional 10 minutes with the patient before releasing him. The physician's level of documentation supports a level-four office visit (99214, Office or other outpatient visit for the evaluation and management of an established patient ...).
 
In this case, you cannot report prolonged services in addition to 99214, Darling says. The CPT reference time for 99214 is 25 minutes. The physician spent a total of 40 minutes with the patient and does not meet the requirement of at least an additional 30 minutes to report 99354. Had the neurologist spent and documented 55 minutes (25 minutes for 99214 + 30 minutes toward prolonged services) or more, however, you could claim 99354 in addition to 99214.
 
Note: You can find a complete list of "threshold times" for reporting prolonged services with individual E/M services [...]