Wiki Prolonged Services

[pjohnson@springfieldnephrology.com]

My NP saw a patient in the hospital and dropped a 99223 for initial hospital care and a 90935 for inpatient dialysis.....in her notes she states that she spent > 75 minutes caring for this patient. My question is ... since the 99223 states "Typically 70 minutes are spent.....", can I or can I not add a 99355 and/or 99357 for the prolonged service. I think I have answered myself (no because the E/M code states the typical time spent), but would like some back up.

 

[Lukelie]

If the selection of E/M is based on time, then you must code to the highest level E/M based on time. Since 99223 is typically 70 minutes and that is what the provider spent with the patient, I would say prolonged services is inappropriate. The provider would have to spend 100 minutes with the patient.