One of our physicians has 2 Medicare billing questions about inpatient prolonged services CPT 99356 with subsequent inpatient E/M Service based on counseling and/coordination of Care.
For example, CPT codes billed 99233+99356
Physician spent 35 minutes on patient floor/bedside with 25 minutes of that time for counseling and coordinating of care plus additional 35 minutes discussing test results with patient and family at the bed site.
1. Question 1: I understand that prolonged services (96356) could only be counted for direct face to face time, but I am not clear if total inpatient visit (if based on time) which includes both E/M and prolonged services should be also be only face to face, or part of the total visit time (that is not counseling/coordination of care- 15 minutes) could be unit/floor time?
2. Question 2: In addition to services above (99233+99356), MD also preformed a procedure (for example, CPT 49083). If procedure' time is separately identifiable from E/M and prolonged service, should we follow the same rules as above, or any specific documentation is needed.
For example, CPT codes billed 99233+99356
Physician spent 35 minutes on patient floor/bedside with 25 minutes of that time for counseling and coordinating of care plus additional 35 minutes discussing test results with patient and family at the bed site.
1. Question 1: I understand that prolonged services (96356) could only be counted for direct face to face time, but I am not clear if total inpatient visit (if based on time) which includes both E/M and prolonged services should be also be only face to face, or part of the total visit time (that is not counseling/coordination of care- 15 minutes) could be unit/floor time?
2. Question 2: In addition to services above (99233+99356), MD also preformed a procedure (for example, CPT 49083). If procedure' time is separately identifiable from E/M and prolonged service, should we follow the same rules as above, or any specific documentation is needed.