Urology Coding Alert

1 rule when reporting add-on codes will make - or break - your claims Urology coders understand that the E/M codes contain a time allotment for performing the service. But what do you do when the urologist goes over that allotted time?

Prolonged service codes (99354-99357) may hold the key to boosting your pay when your urologist spends more than the usual face-to-face time allotted for E/M services.

Here is a closer look at the prolonged service codes, when to use them, and what your prolonged service claim should look like before sending it to the carrier. Report 99354-99357 When Crossing Threshold Time A urologist performs a level-two E/M service on an established patient that takes 50 minutes.

Example: An established patient comes for a routine follow-up for BPH worsening on medication. The E/M level is limited to 99213 because the urologist documents only a pertinent review of systems as part of the patient's history. The urologist ends up spending more time with the patient than the 15 minutes that 99213 specifies.

In this case, you should report a prolonged service code with the E/M code on this claim.

The claim should read:

99213 - Office or other outpatient visit for the evaluation and management of an established patient ...

+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).   Tip: Use 99354 for the first 30-74 minutes of outpatient prolonged service time and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) for each additional half-hour for outpatients beyond 74 minutes.

Remember: To use the first-hour prolonged service codes, the urologist must have provided at least 30 minutes of service time beyond the CPT Codes -allotted "threshold time" for that E/M service, coding experts say. Also note that prolonged service codes are add-on codes, so you should never report prolonged service codes alone, coding experts say. And you do not need to add a modifier to an add-on code when you report it with an E/M code.

Bottom line: The prolonged service time must be face-to-face time between the physician and patient. If you haven't met that requirement, the prolonged service codes are not applicable.

Important: In order to report the E/M code on time [...]