Results 1 to 4 of 4

Prolonged Services

  1. #1
    Thumbs up Prolonged Services
    Medical Coding Books
    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.
    Felicia A. Thomas, CPC
    Atlanta, GA

  2. #2
    Default
    Quote Originally Posted by feliciathomas View Post
    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.
    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
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default 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

  4. #4
    Thumbs up
    Thank you ladies for your insight... I am going to pass this info along...
    Felicia A. Thomas, CPC
    Atlanta, GA

Similar Threads

  1. Prolonged services
    By maryanneheath in forum E/M
    Replies: 11
    Last Post: 03-17-2016, 02:05 PM
  2. prolonged services
    By rebec26@juno.com in forum E/M
    Replies: 0
    Last Post: 02-25-2015, 11:03 AM
  3. Help on prolonged services
    By tsmaldone in forum Medicare Regulations
    Replies: 7
    Last Post: 08-09-2010, 07:40 AM
  4. Prolonged services
    By tsmaldone in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 08-04-2010, 04:04 PM
  5. Replies: 0
    Last Post: 05-15-2009, 12:16 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.