Wiki Prolonged Services

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ylizcontreras

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I was recently unable to answered a question about prolonged services and would like your assistance. CPT states that in order to bill 99356 physician must spend one hour face-to-face. However the table states first 30-74 minutes. Does it have to be one full hour before the code can be use?
 
The first hour

CPT allows for rounding up when you have spent at least half the recommended time frame ... therefore the first hour is from 30 minutes (a half-hour is rounded up to a full hour) to 74 minutes (because when you hit 75 minutes .. i.e. 15 minutes after the first hour ... you'd round-up to an additional 30 minutes.)

I found it best to stop trying to figure this out and just believe the chart on page 26 (CPT 2009 professional edition) or page 19 (same reference).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Tessa, I was just looking at p. 26 BEFORE I saw your answer and I'm wondering how to tell my doctor that his 45 minute face to face time with patients does not justify the addition of the prolonged service code. It just seems so unfair that due to a "5" minute lapse, no additional service will be paid. ---Suzanne
 
Prolonged service

Suzanne,
If you physician fully documents his level of service, AND then states that s/he spent at least 30 minutes of additional face-to-face time with the patient, you can code the prolonged service codes.

The problem may be that your physician is ONLY documenting total time ... that's not enough to clarify what portion was spent in documenting the basic E/M and what portion was "prolonged." Of course, if you are billing ENTIRELY based on time spent in counseling/coordination of care, you'd have to have at least 30 minutes MORE time than that required for the highest level of service.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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