Urgent help needed for my providers understanding for the use of prolonged service codes.

My understanding is that they are to be used when a provider exceeds the time for the E/M visit and they are still with the patient providing face to face service over 30 minutes during the same session.

They want me to define what same session means, because they think, that if they see a pt for DM in the morning and spend 25 minutes with that patient face to face, then in the evening they are called to see the patient because the patient fell due to gait instability and they spend an additional 35 minutes with the patient that the second interaction, qualifies them to use the prolonged service code 99356 because they added the two visits time together.

They are looking at 'same session' as all time spent for that day with the patient.

I am saying 'same session' is per encounter for the same presenting problem that may have worsened during the day and the provider came back to re-evaluate and treat the patient, which resulted in additional time over and above the first E/M level that constitutes the use of prolonged service code.

Can my faternity give me guidance please?


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