Use Prolonged Services to Capture Extra E/M Time
Published on Wed May 01, 2002
Many coders are confused about when to code for time and when to use the prolonged service codes. When an E/M visit exceeds the standard amount of time by 30 minutes or more, physicians should use the prolonged service codes (99354-99357) in addition to the E/M code.
"You code based on time when counseling or coordination of care dominates (i.e., consumes more than half the face-to-face time) the encounter in the office," says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians. "When that happens, you code based on total time the physician spent with the patient compared to typical time in CPT." Thus, if a visit spent predominantly in counseling or coordination of care meets or exceeds the typical time for an E/M service, e.g., 99215 (physician usually spends 40 minutes), report that code. "The prolonged services codes, on the other hand, allow you to capture time over and above the typical time when you are coding the E/M based on history, exam and medical decision-making," Moore says. 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]) when an office visit is 30 to 74 minutes longer than the typical time for that service. If the service surpasses 74 minutes beyond the typical time allotted for each E/M level, use +99355 ( each additional 30 minutes [list separately in addition to code for prolonged physician service]) in addition to 99354.
"The prolonged service must be face-to-face with the patient," says David Berland, MD, the AMA CPT adviser for the American Academy of Child and Adolescent Psychiatry. "If the doctor is taking extra time during a visit, but coming in and out of the exam room, or leaving that patient with a nurse for periods of time, the prolonged service codes cannot be used.
"Do not report a prolonged service time of less than 30 minutes," Berland says. "It is included in the E/M code." Subtract the typical time for the E/M visit from the total time spent with the patient. If the remainder (i.e., the prolonged part) is 30 minutes or greater, use a prolonged service code. For example, if the doctor spent 55 minutes in a 99215, the typical time for which is 40 minutes, the prolonged part of 15 minutes cannot be separately reported. The following vignettes illustrate appropriate use of the prolonged service codes: Case #1: A new female patient presents with allergies. After performing [...]
