Neurosurgery Coding Alert

Here's the scoop on 99354  If your neurosurgeon provides an extended E/M visit, you may want to report 99354. But unless the surgeon spends at least 30 minutes beyond the CPT reference time for the E/M level you choose, using 99354 is overbilling. Maintain a '30 Minutes Over' Minimum  Prolonged services codes are a valuable reimbursement tool, but they require that you track and document time carefully. 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]) the surgeon 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, the neurosurgeon takes an emergency appointment in the office for a patient who has fallen from the roof of his home while doing repairs. The patient has  dizziness and acute back pain. The surgeon spends 30 minutes evaluating the patient. Confident that the patient is not in immediate danger, the surgeon 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 thereby does not meet the requirement of at least an additional 30 minutes to report 99354. Had the surgeon spent and documented 55 minutes (25 minutes for 99214 + 30 minutes toward prolonged services) or more, 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 in the last sentence of each CPT code definition, or in the Medicare Carriers Manual, section 15511.1, subsections "E" and "F."

Apply 99355 for Time Beyond the First Hour If the physician supplies prolonged services beyond an hour, you should report additional time using +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]), Darling says. To use 99355, the physician must spend at least 15 minutes of [...]