Wiki Prolonged Services

[Linda McMann]

One of my fellow coders in our medical group raised a question regarding the usage of prolonged services code in the office [99354 and 99355]. The guidelines say face-to-face with patient and she questions if we can still use them if the physician must step out of the exam room to confer with an outside physician regarding that patient. It is not a problem at my site as all exam rooms have a phone, but there are no phones in the exam rooms at her office. My question is this: Can the phone time outside the exam room be counted towards fulfilling the time requirement of the prolonged services codes? Thanks for any help.

 

[brookievb]

Hi Linda,

No, I do not believe the phone time spent outside the exam room can be counted for prolonged services.

As the definition states, 'Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service', I think you'll run into payers who would hold a strong & valid argument against paying this code.

A payer will not be able to review documentation and know that there are only telephones outside a patient room. They will review the documentation and think the provider stepped out to speak with another provider and deny prolonged services as it's not face-to-face.

Hope that helps!

 

[L4uniki]

Prolonged

The extended question here is whether this develops into a referral for consultation; if so, you cannot code prolonged services... also, does the prolonged service pertain to the chief complaint of this appointed encounter, or is the time allotted for a new complaint by the patient. Check your E/M guidelines.

 

[Linda McMann]

Thanks for your input. I wanted to see if others read the guidelines and interpreted them the same as I did. I'll pass this info along to my fellow coder.