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How to code for observation at OV


Chantilly, VA
Best answers
Twice now this week we have had the scenario where a pation comes in with an allergic reaction to ......... in both instances the physician drugged them up on solumedrol and benadryl IM and then had the patient observed in the office for over an hour. the physician was not in constant attendance as with the critical care codes. Is there something else I can bill besides the level 3 E &M?

Mary Jane Bruette
RBRC Management Services, Inx
Milwaukee WI
Best answers
Prolonged Service CPT 99354 - MAYBE

If your physician's TOTAL face-to-face time over the period of observation adds up to 30 minutes or more, you could bill the level 3 E/M as per the bullet points, AND then prolonged service 99354 (30-74 minutes over and above the E/M).

Physician's documentation should include the basic bullets points for the level of E/M AND a statement along the lines of: I spent an additional 30 minutes of direct prolonged service with the patient monitoring response to Tx for acute allergic reaction.

The time does not have to be continuous but can be cumulative over the observation period.

2008 CPT Professional edition pg 28-29 gives the guidelines etc for the prolonged service codes.

Good luck, and let us know how it works out.

F Tessa Bartels, CPC, CPC-E/M