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Neurology & Pain Management Coding Alert

Reader Question:

Prolonged Services

Published on Wed Dec 19, 2012

Question: I recently received a denial from Medicare for 99356 billed on the same day as 99255 (initial inpatient consultation, highest level, physicians typically spend 110 minutes at the bedside and on the patients hospital floor or unit). The patient was seen as a consult in the hospital (99255) and spent several hours back and forth to the intensive care unit while the physician helped to stabilize (99356) her.

New York Subscriber

Answer: As per the introductory text in CPT 2001 for prolonged services, these codes are to be reported in addition to other physician services, including an E/M at any level. Time is a very important factor to consider when billing prolonged service codes in addition to an E/M service. If your documentation reflects that the total time spent with the patient supports the level five E/M (typically 110 minutes) plus one [...]
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