Prolonged Services

[cyprice]

Can prolonged services be billed for observation for head injuries and allergic reactions? Per provider, all references suggest the patient be observed for a minimum of 4 hours. According to MM5972 by MLN Matters, you cannot bill for prolonged services for waiting for changes in the patient's condition, which leads me to think that the observation time is not billable. Any insight would be greatly appreciated.

Thanks,
Cyndi

 

[FTessaBartels]

Can only count FACE-TO-FACE time

Prolonged services can only be billed for that FACE-To-FACE time the physician spends with the patient. So it is POSSIBLE to use the prolonged service codes for a patient kept in the office checking for allergic reaction, but not for the four hours the patient spends sitting/lying around ... only for that actual time the physician spends at the patient's side.

You add up all the small increments and if you have at least 30 minutes then you can use the prolonged service code. It's best if the documentation includes an in/out time line for the physician to log, so there is no question as to what time the physician spent with the patient over and above the E/M service.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[cyprice]

Thanks, Tessa. Your response further supports everything I've been able to find.