Prolonged care/discharge same day

sknapp56

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I am new to pediatric hospital coding and need help. Newborn had seizures and physician did prolonged care, lumbar puncture and discharge to another facility with a NICU. I need help coding this discharge. I don't think I can use the hospital 9923?, and 99356 and a discharge code on the same day. Help please. Thank you in advance for any help you can give me.
 
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Milwaukee WI
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Critical care?

Without seeing all the notes ... I'm thinking that it's possible that you should be coding critical care 99291-92 for the care provided to this infant. The LP would be separately codeable, I believe.

Read all the guidelines in CPT re critical care to be sure you have all the documentation you need.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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E&M, prolong and discharge same day same provider

Provider has 99233 and prolong 120 minutes with statement "An additional 120 minutes was spent on face-to-face patient care beyond usual service with 120 minutes dedicated to counseling and coordination of care." Provider wants to bill 99356,99357x3. A separate discharge note stating greater than 30 minutes.
After reviewing thread: Can the rounding 99233 and prolong be combined into critical care time and then bill discharge?
 

mitchellde

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If you look in the code book you will under the 99356 the list of codes that prolonged time can be used with. this does include the 99233 however you do need total time spent with the patient and not just additional time. If you only have the 120 minutes documented then you will need to use that as the total time spent so you must back out the first 35 minutes for the 99233 to give you only 85 minutes of prolonged time. for a 99356 and a 99357 with 1 unit
FYI even if after backing out the visit level if you were left with 120 minutes it would give you the 99356 and 2 units of the 99357 not 3 units. In addition the LP must not be included with in this time frame or the toime spent on the LP will need to be extracted out.
 
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Prolong visit and discharge

Thank you for guidance with 99233 and prolong. Next question, is the provider able to bill all (visit+prolong) at discharge same day? Provider has separate notes for each.
 

mitchellde

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Again look in your CPT book.. The 99356 can only be appended to the codes listed. This does not include the 99238-99239.
 
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