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Prolonged Services

  1. Default Prolonged Services
    Medical Coding Books
    I bill for a Hematology-Oncology office and we have an instance where the patient's family walked in to discuss the treatment plan/prognosis of a family member and the physician spent approx 45 minutes with the family. The patient was seen a week prior to them coming to the office. We billed the appropriate E&M code for that vist but due to family visit being after the patients visit and the patient not being there, can't we add an E&M code 99358 for prolonged services non face-to-face for these services?


  2. #2
    Milwaukee WI
    Default Established patient visit
    This is not prolonged service (which is an add-on code and must be coded the same date of service as the basic E/M)

    You can use the counseling/coordination of care rules (mentioned a bijillion times on these forums) to cover this service. Refer to the guidelines in your CPT book.

    Your documentation must include:
    1) total time spent face-to-face with patinet or family member(s) responsible for medical decision making
    2) amount of time spent in counseling/coordination of care (must be >50% of total time)
    3) nature of the counseling/coordination of care
    4) if patient is unavailable for a medically necessary reason - the reason why the patient could not be present for the visit.

    Example: I spent 45 minutes in counseling with Patient's family today. 100% of this visit was counseling, discussing the treatment plan/prognosis and risks/benefits of various treatment options. Patient is unable to participate due to critical nature of his illness and need to limit contact with others for infection control.

    45 minutes would qualify for 99215.

    F Tessa Bartels, CPC, CEMC

  3. Default prolonged services
    Thank you very much for you help... Medicare isn't going to pay anyway...LOL LOL

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