Prudent Use of Prolonged Services Can Be Profitable
Published on Wed Mar 01, 2000
Prolonged services are a good way for otolaryngologists to get reimbursed for significant extra time spent caring for patients. Physicians treating pediatric patients and those with cancers of the neck, throat or thyroid, for example, particularly stand to benefit financially by coding and billing for prolonged services when appropriate.
There are, however, two hurdles to overcome before these benefits can be realized:
1. Many practices are unfamiliar with billing these
evaluation and management (E/M) services.
2. Many otolaryngologists dont document their time
adequately, but time is the critical compliance guideline when using and billing for these services and the key to successful reimbursement.
There are two sub-categories of prolonged services in CPT 2000direct, or face-to-face contact, and without direct contact. From a reimbursement standpoint, the face-to-face codes are more important because most carriers wont pay for nondirect prolonged services.
The face-to-face codes are further categorized as inpatient or outpatient. There are four such codes:
99354prolonged 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)
99355each additional 30 minutes (list separately in addition to code for prolonged physician service) (Note: This code follows 99354.)
99356prolonged physician service in the inpatient
setting, requiring direct (face-to-face) patient contact beyond the usual service (e.g., maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); first hour (list separately in addition to code for inpatient evaluation and management service)
99357each additional 30 minutes (list separately in addition to code for prolonged physician service) (Note: This code follows 99356.)
Four Coding Tips
1. Prolonged Services Codes Cant Be Used on Their Own. The first thing to note about prolonged services codes is that they are add-on codes, which means they cannot be billed on their own but must accompany another E/M service, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent coding and reimbursement specialist in Lakewood, N.J. And because these codes are time based, they can be added only to E/M services that have a time component, or reference time, built in, Cobuzzi says, such as hospital admissions, inpatient follow-up care, consults or office visits.
Note: When more than 50 percent of the physician/patient or physician/family encounter is spent counseling or coordinating care, time supersedes history, exam and decision-making and becomes the key factor for determining the E/M service level.
Billing a prolonged service code as an add-on to an emergency department visit code (99281-99285) is incorrect, however, because these codes are timeless in [...]
