Learn what CMS has in store for you -- and how it will affect E/M coding Coding for prolonged services can be intimidating, but there should be smoother sailing ahead thanks to upcoming changes from Medicare. Find out what's in store so you can capture every dollar your practice earns. Bone Up on Prolonged Services Essentials For office or outpatient services, your face-to-face prolonged service coding options are +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]) and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]). Remember: Prolonged service codes are add-on codes, and you must report them alongside E/M services. Do not report prolonged service codes alone, and never attach them to procedure codes. Tip: Recent CMS Transmittal 1490 includes a list of companion codes for 99354 and 99355 (
http://www.cms.hhs.gov/transmittals/downloads/R1490CP.pdf). Watch the clock: CPT sums up the time requirements for 99354 and 99355 in the following way: Update: For Medicare, the provider must document the visit start and end times in the medical record with the date of service, according to Transmittal 1490, effective June 2, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, with MJH Consulting in Denver. Notice that you should not report prolonged services separately when they total less than 30 minutes for the day, according to both CPT guidelines and Transmittal 1490. Example: A neurologist takes 25 minutes to complete a level-three E/M service on an established neuropathy patient. Code 99213's descriptor (Office or other outpatient visit for the evaluation and management of an established-patient -) says, "physicians typically spend 15 minutes face-to-face with the patient and/or family." You should not report a prolonged service code, because the 25 minutes the neurologist spent with the patient minus the typical 15 minutes equals 10 extra minutes. The neurologist did not meet the 30 extra minutes required to report a prolonged service. Expect Separate Rules for Time-Based E/M Choice Red flag: When you choose an E/M code based on time, prolonged service rules have always been different. And Transmittal 1490 clarifies that for prolonged services with E/M codes based on counseling and/or coordination of care (time-based), "the time approximation must meet or exceed the specific CPT code billed (determined by the typical/average time associated with the evaluation and management code) and should not be -rounded- to the next higher level," Hammer says. Translation: If the E/M service level is based on time spent in counseling [...]
