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Prolong Service in ER.

  1. #1
    Default Prolong Service in ER.
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    I am new to ER billing and was wondering if we can use Prolong CPT codes along with our E/M codes if a physician or Extender spends a great deal of time with a pt. I know we can use critical care time if the pt is critical but in these cases the pt is not.

  2. #2
    Location
    Columbia, MO
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    12,573
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    no you cannot use prolonged time codes wth ER E&M codes since there is no time component to those codes

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Since the E/M codes for ER are not time based, you are not able to use prolonged services. The CPT states "The use of the time based add-on codes requires that the primary evaluation and management service have a typical or spee published in the CPT codebook."

    Hope this helps.

    Robyn O'Neal CPC,CEMC
    Denver, CO

  4. #4
    Default Thanks
    I went to Seminar Tuesday and the lady speaking said that the Prolong Service codes had been reworded and that we could now use them. I just wanted to double check before I told my docs.

  5. #5
    Location
    Columbia, MO
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    Sorry she is mistaken, the 99358 and 99359 were reworded and 99358 is no longer add on , but those are prolonged non face to face.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    So would that mean that we can bill for them instead of ER E/M? I know ER E/M codes are not based on time like other E/M codes. I just want to make sure that I understand it correctly.

  7. Default
    You cannot bill them... you can ONLY bill the 99281-99285 range unless cc was performed and documented.

  8. #8
    Default
    From my experience, we CAN bill out the 99354-99359 WITH the E/M. According to AMA CPT, it clearly states: "This service is reported in addition to other physician services, including evaluation and management services at any level." I have billed and been paid for these services along with the ED E/M.

  9. #9
    Location
    Columbia, MO
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    If you look at the 99354 you will see it is restricted to only certain codes. You cannot add prolonged time to any code that does not have a timed component and that includes Er codes.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Location
    Milwaukee WI
    Posts
    4,466
    Default No prolonged service with ER
    I agree with Debra. Face-to-face prolonged service can ONLY be added when the basic E/M service has a time component. ER services do not have any "typical time" associated with them, so you cannot use the face-to-face prolonged service codes.

    As an alternative, however ... if the patient is critically ill and the care provided qualifies as critical care, you could use those codes (99291-99292) instead of the ER service codes.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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