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Time based coding for Inpatient subsequent

  1. #1
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    Santa Rosa
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    Question Time based coding for Inpatient subsequent
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    I'm a little unclear on the time based coding and the prolonged care stuff. Does anybody have input on the following situation?
    Physician sees a patient in subsequent care to only meet the 99231 level. But...physician spends 2+hrs face to face with the patient(and family) talking to them about end of life issues(palliative care).
    Would I code the 99231 plus prolonged care or 99233(based on time) plus the prolonged care?
    Help please???
    Thank you!!

  2. Default
    Quote Originally Posted by dentfam View Post
    I'm a little unclear on the time based coding and the prolonged care stuff. Does anybody have input on the following situation?
    Physician sees a patient in subsequent care to only meet the 99231 level. But...physician spends 2+hrs face to face with the patient(and family) talking to them about end of life issues(palliative care).
    Would I code the 99231 plus prolonged care or 99233(based on time) plus the prolonged care?
    Help please???
    Thank you!!


    Hope this could give a better and clear scenerio:

    For Code number 99231 the Level is 1- the Time spends is 15minutes.
    Prolonged Physician Service with Direct( face to face) contact –all add on Codes. Should be reported in addition to the designated E/M services at any level and any other physician services provided at the same session as the evaluation/management services.
    The total Duration of prolonged Services in your case, would be 105minutes.
    Your Prolonged Services code (with face to face) in inpatient setting is 99356- for the First hour. (beyond the usual service of your E/M service)
    You have remaining ( extra) additional time of 45minutes. So each additional 30minutes (list separately) in addition to the above. Now the code 99357 also adds up.

    SO YOUR PHYSICIAN WOULD CODE AS FOLLOWS:
    99231 +99356(ONCE) AND 99357 ( remaining 10 minutes can not be reported for)
    Last edited by preserene; 07-23-2010 at 02:27 AM.

  3. Default
    However, for your query, the diagnoses and the present problem severity is to be given a perusal; Check with your Physician if the documentation falls with 99231 (once again). However there is a factor 'Counceling and /or Coordination of care which could help to justify the prolonged Service face to face Service Time.
    As Coder, we code as per the documented service. how could we shift to 99231 to 99233 just because of prolonged Physician Face to Face service.

    It is a real Challenging coding situation!

  4. #4
    Location
    Columbia, MO
    Posts
    12,573
    Default
    Quote Originally Posted by preserene View Post
    Hope this could give a better and clear scenerio:

    For Code number 99231 the Level is 1- the Time spends is 15minutes.
    Prolonged Physician Service with Direct( face to face) contact –all add on Codes. Should be reported in addition to the designated E/M services at any level and any other physician services provided at the same session as the evaluation/management services.
    The total Duration of prolonged Services in your case, would be 105minutes.
    Your Prolonged Services code (with face to face) in inpatient setting is 99356- for the First hour. (beyond the usual service of your E/M service)
    You have remaining ( extra) additional time of 45minutes. So each additional 30minutes (list separately) in addition to the above. Now the code 99357 also adds up.

    SO YOUR PHYSICIAN WOULD CODE AS FOLLOWS:
    99231 +99356(ONCE) AND 99357 ( remaining 10 minutes can not be reported for)
    If you follow the CPT chart you codes would be:
    Based on 2 hours time documented with a 99231 documented as a visit level. total time 120 minutes minus the Visit equals 105 minutes
    Now follow the chart
    30 - 74 minutes = 99356
    75- 104minutes = 99356 and 99357
    105 - and up = 99356 and 2 units of 99357 so you would have
    99231
    99356
    99357 x 2 units

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Thank you very much, Michellde got it. I missed the boat!

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