prolonged services - need help

Colliemom

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Good morning,

So we have a provider who submitted a 99309, which was paid, and then she added a 99358 and 99359 to the encounter, which were denied. The claim was denied, stating a modifier was needed. First, do you all agree these were the correct codes for the services outlined below? And second, I am getting a red edit (showing the CPT codes can never be billed together, not even with a modifier) when I run these codes through our CCI edits. So do you have any experience with this?

Patient was seen for a cough, but when the APRN went into to see the patient (in a nursing facility) the patient was found unresponsive. No respirations, no pulse, CPR initiated. 47 minutes spent doing chest compressions, bagging and intermittent meds. ER physician directed the APRN and EMS to stop CPR. The APRN then called family to notify them, called the conservator, called the funeral home, D/C the body to the funeral home, and filled out the death certificate. Total time spent on the case and in coordination of care was 120 minutes.
 

Colliemom

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New Haven, CT
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I am also wondering if we should be using 99356 and 99357, as the first 47 minutes was spent with the patient, and these codes specify "direct face-to-face contact and includs additional non-face-to-face services on the patient's floor or unit in the hospital or nursing facility during the same session."
 
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308
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Good morning,

So we have a provider who submitted a 99309, which was paid, and then she added a 99358 and 99359 to the encounter, which were denied. The claim was denied, stating a modifier was needed. First, do you all agree these were the correct codes for the services outlined below? And second, I am getting a red edit (showing the CPT codes can never be billed together, not even with a modifier) when I run these codes through our CCI edits. So do you have any experience with this?

Patient was seen for a cough, but when the APRN went into to see the patient (in a nursing facility) the patient was found unresponsive. No respirations, no pulse, CPR initiated. 47 minutes spent doing chest compressions, bagging and intermittent meds. ER physician directed the APRN and EMS to stop CPR. The APRN then called family to notify them, called the conservator, called the funeral home, D/C the body to the funeral home, and filled out the death certificate. Total time spent on the case and in coordination of care was 120 minutes.
If the APRN performed/supervised CPR or provided critical care of at least 30 minutes (not including time of other reported services), are you billing for those services? My first thought is you either have 92950, 99291-99292, or both. Subtract the time of CPR from the time of critical care if reporting both. The time of calling the conservator, funeral home, and completing the death certificate are post-service work and not reported as prolonged service. I don't believe 99309 adequately describes the service rendered and it would be highly doubtful that the APRN spent more than 50% of the time of the visit in counseling and/or coordination of care to a patient who is unresponsive. Would suggest reviewing the documentation again and submitting a corrected claim based on the services provided and documented.

I hope that makes sense and is helpful.
Cindy
 
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