Wiki Prolong Services

[Gemini18]

Hello -

I have a physician who used E/M code 99233 with 99356. After auditing this record and seeing that he states in the medical record - "Total time spend to talk with family = 50 min), I cannot use 99356. E/M 99233 says 35 minutes, the prolong services says "less than 30 minutes - Not reported". What code can I use instead?

Thank you.

 

[ARCPC9491]

You can only bill 99233. If the prolonged service was less than 30 minutes, it is not seperately reportable.

 

[FTessaBartels]

Let's clarify

Was the TOTAL time spent in the visit 50 minutes? Then AR is correct .. just code the 99233.

BUT .. was the 50 minutes spent talking to family over and above the exam/eval of patient?

A physician may be able to complete a level of service in much less time than what is noted as the average. For prolonged service, you code based on the additional time spent (minimum 30 minutes). So if your physician has documented a 99233 note (not based on time, but based on meeting the key elements), AND then he notes "an additional 50 minutes spent discussing ... " you would be able to bill prolonged service.

Using that "additional" phrasing really helps to identify when prolonged service is applicable.

Note, too, that I believe CMS now requires that for prolonged service you actually document your start and stop time. (I'm not sure about this because I'm in Pediatrics and we rarely bill Medicare.)

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[Gemini18]

Thanks Guys for your responses -

To answer your question Tessa -

He wrote "total time spent to talk with family = 50 mins". This is where I got confused, it looks like the total time spent all together.