Reader Question:
Prolonged Service
Published on Mon Oct 01, 2001
Question: An oncologist in our practice admitted a patient for observation. He was told that he could not bill Medicare for any E/M services. Can he bill for prolonged service time?
Louisiana Subscriber
Answer: On occasion, an oncologist may be required to admit a patient to a hospital observation unit. Perhaps a patient had an adverse reaction to chemotherapy or supportive-care drugs, which require hospital attention, but is not serious enough to warrant inpatient admission.
While the physician may bill observation services, 99217-99220, he or she cannot bill for a separate E/M service because it would be like billing twice. All services performed on that day of outpatient admission including those E/M services in the office should be included in the initial observation care codes selected.
The prolonged service codes are add-on codes and must be attached to another procedure code to be paid. Medicare allows the addition of +99354-+99357 to E/M services, including outpatient observation.
However, reporting prolonged service must be a function of additional care that falls outside what is normally considered usual service. And prolonged service must describe face-to-face contact between the physician and patient.
To help determine whether adding on a prolonged service code is justified, follow these basic rules:
The codes may be added to any other physician service, including evaluation and management services.
Use prolonged service codes to report the total duration of face-to-face contact, even if the time is not continuous.
Prolonged service codes may be used only once per date of service, even if the time spent with the physician was not continuous.
If the prolonged service was less than 30 minutes, 99354 is not separately reportable and the service provided should be included with the normal E/M service codes.
Although 99355 is used to report time spent with the patient beyond the first hour, the additional time must be between 15 and 30 minutes. If the time is less than 15 minutes, 99355 should not be reported in addition to 99354.
-- Reader Questions and You Be the Coder were answered by Lillie McAlister, CPC, president of Double-Diamond Enterprises, a coding and billing consulting firm in Conroe, Texas; Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies in Dallas, Ga.; and Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.
