According to the CPT guidelines, pg 28 "this service is reported in addition to other physician services, including evaluation and management services AT ANY LEVEL." If the documentation for the exam and medical decision making was appropriate for a level 3, but the time that was spent went well over the normal time for that level(and this was documented) then this billing would be appropriate. However, CMS is conducting a pre-payment review on ALL prolonged visit encounters and is generally denying them. There must be documentation of the time for the original E/M level and then additional documentation of time for the prolonged visit code. They are requesting all supporting documentation. They will review both the medical necessity of the original E/M code and the medical necessity of the prolonged visit. This could result in denial of the prolonged visit along with a reduction of the original level if documentation is not supporting.
Hope this helps.
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