Neurology & Pain Management Coding Alert

Question: Can I report 99354 for prolonged services in an inpatient setting?

Kansas Subscriber Answer: No, you should not report +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]) in an inpatient setting.

Correct tactic: Instead, submit +99356 (Prolonged physician service in the inpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring, prolonged care of an acutely ill patient]; first hour [list separately in addition to code for inpatient evaluation and management service]). If your neurologist provides a service that lasts more than an hour, add +99357 (- each additional 30 minutes [list separately in addition to code for prolonged physician service]) for each 30 minutes past the initial hour.

Document it: Before reporting any of the prolonged services codes, be sure your neurologist thoroughly documents the reason for the extended time.