Pause Before Using Prolonged Services Codes
Question: When am I allowed to use prolonged services codes? Answer: Prolonged services codes are for physicians who spend a significant amount of time, at least 30 minutes, greater than the American Medical Association's time limit guidelines for a given level of E/M service. You can only use the prolonged services codes for E/M services, not procedures or diagnostic tests.
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Example: If a physician takes 10-15 minutes longer than usual to complete an E/M service, you cannot report a prolonged service code.
Remember that +99354 (Prolonged physician service in the office or other outpatient setting ...) or +99356 (Prolonged physician service in the inpatient setting ...) is for the first hour of prolonged service time and that you should report +99355 (... each additional 30 minutes) or +99357 (... each additional 30 minutes) for each additional half-hour, respectively. Codes 99354 and 99355 are for office/outpatient settings, and 99356 and 99357 are for hospital/inpatient settings.
Important: Prolonged service codes are add-on codes, which means you must tag them to other E/M services. Also, the physician must document the encounter time as well as the reason why a prolonged service was necessary.
Mistake: If you think modifier 21 (Prolonged evaluation and management services) is an easy fix to account for any extra E/M time that doesn't meet the prolonged services code time requirements, think again.
First, you can only use modifier 21 for top-level E/Ms. But more important, modifier 21 is informational only, so it won't help earn any extra dollars for your practice.
