Prolonged Services

feliciathomas

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Was hoping to enlisted the help of others with this scenario:

I work for Endocrinologists... They have a patient with uncontrolled diabetes come in the office to run a Glucose Tolerance test. This is a 2 hours test which requires them to check on the patient periodically.

They want to get reimbursed for their time, but do not want the patient to incur an office copay for this lab test. I am considering the following submissions:

99358
99359
8xxxxx

Would this scenario be correct. :confused:
 

rthames052006

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Was hoping to enlisted the help of others with this scenario:

I work for Endocrinologists... They have a patient with uncontrolled diabetes come in the office to run a Glucose Tolerance test. This is a 2 hours test which requires them to check on the patient periodically.

They want to get reimbursed for their time, but do not want the patient to incur an office copay for this lab test. I am considering the following submissions:

99358
99359
8xxxxx

Would this scenario be correct. :confused:
I am not sure you want to bill these codes, as I am reading thru my CPT book the description for the code you are wanting to use states>

Prolonged e/m service before and /or after direct (face to face) pt care (eg, review of extensive records and tests, communication with other professionals and/or th epatient/family), (List separetely in addition to code(s) for other physician services and /or inpatient or outpatient e/m services).

You also might want to check with this pt's insurance carrier, there are not alot of insurance that I am aware of that pay for these codes mainly because their is no face to face and there is a chance the pt will have a copay as it is an e/m service you are billing. I would first check with the carrier then go from there.

Best of luck
 
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Prolonged Service

First: You say the doctor doesn't want the patient to incur an office co-pay for the test. Aren't you billing an E/M at all? You should be ... and you will have to in order to bill the prolonged service codes, since they are add-ons.

Now ...Roxanne has a good point ... you don't want the non-face-to-face codes. You'd want the 99354-55 series. BUT ...

The time used for "prolonged service" cannot be also part of another procedure/process. I'm not positive (since I work for surgeons), but if the Glucose Tolerance test you refer to already assumes the length of time, then I don't think you can capture that "procedure time" as prolonged service.

Finally, I think that IF the glucose tolerance test does NOT include the time of physician supervision, the periodic checks made by the doctor can be added together to determine the amount of time eligible for prolonged service face-to-face. This would require that your physicians keep a detailed log in/out for each of these checks so you could add the time together to arrive at the requirement for prolonged service (has to be at least 30 minutes over and above the E/M).

I hope I'm making sense ...

I think you might want to check with the national profesional association (Endocrinologists or Internal Medicine) to see if they have guidance on this. It may be best to bill the higher level E/M that the patient's condition (uncontrolled diabetes) warrants.

I hope that helped.

F Tessa Bartels, CPC, CEMC
 
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