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Wiki 5 Hour visit

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NESmith

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Zephyrhills, FL
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Our office had a patient come in with chief complaint of 1 day weakness/dehydration/hyperglycemia with mild hand/foot spasms & fatigue. The visit ended up being 5 hours for ongoing medical care and treatment, stabilization, IV fluids, glucose control, patient education, disease management & coordination of care because the patient refused ER evaluation and hospital admission. The physician wants to bill an acute care cpt code but I disagree because the entire visit was not face-to-face with the patient. I think this should be billed with the E/M code of 99215-25 96360 x 1 and 96361. The IV was started at 12:00 and at 1:30 the 2nd bag was started at 3:00 pt went to bathroom and came back and had infiltrated the IV site Could not insert new IV and the 2nd bag was almost complete. pt d/c at 4:00. Please help and as always Thank You in advance.
 
Take a look at the prolonged services codes w/ direct face-to-face 99354-99357

you would just have to break out the face to face time spent that was above the normal visit. According to CPT it doesn't have to be continuous. So a total of all time spent BEYOND the normal E/M visit.
 
BUt do NOT count

But do NOT count the time for the infusion if you are billing that service separately.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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