Pulmonology Coding Alert

Experts answer your prolonged services FAQs

Are you a little shaky on which in-office prolonged service codes to use when your pulmonologist spends extra time with patients?

If so, relax. Experts answer some common questions to help your prolonged service coding seem less daunting. Q. When should we use prolonged service codes? You should report prolonged care codes (99354-99355) only for your pulmonologist's face-to-face patient service "that is beyond the usual service in either the inpatient or outpatient setting," according to CPT. You shouldn't use prolonged care codes when nonphysician staff treat a patient. Also, you only report these codes in addition to other E/M codes that reference a specific time, such as established patient services (99211-99215).

Tip: Use prolonged service codes as add-on codes when an E/M visit exceeds the highest level of basic E/M service such as 99215. You should avoid using 99354-99355 for an E/M service less than a level four or five, says Antoinette Revel, CPC, a coding expert and nurse practitioner working at Healthcare Consulting Services in Warrington, Pa.

For example, a patient with a history of asthma (493.9x) presents with chronic obstructive asthma (493.2x) and moderate respiratory distress (518.82). During an initial evaluation, your pulmonologist finds wheezing (786.07) and difficulty breathing (518.82). Then your physician performs intermittent bronchial dilation (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device) and injects subcutaneous epinephrine (J0170). Overall, your pulmonologist spends two hours in direct contact with the patient.

You should code your physician's E/M service as 99214 (Office or other outpatient visit ... for an established patient), which allots doctors 25 minutes to perform the service. In addition, you could assign +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]) for the first hour of your physician's prolonged service, and use +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) for each additional 30 minutes. But you cannot bill for fragments such as five or 10 minutes.

Prior to using these codes, know how to calculate your physician's time - which may be harder than you think, says Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.

For instance, your physician spent 120 minutes with the patient, 25 [...]