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What does Prolonged Services cover?

  1. #1
    Location
    Daytona Beach, FL
    Posts
    742
    Default What does Prolonged Services cover?
    Medical Coding Books
    I need some clarification on what prolonged services would cover for one of my Hospitalists. She questioned if Prolonged services could be billed also for the time that she spends speaking with the patient's family. Apparently she will have a meeting with the patient's family to discuss their concerns and this meeting is not necessarily in the same room as the patient, so it is not face-toface with the patient, but face-to-face with the family.

    If this cannot be billed as Prolonged, is there another way that this time can be billed?

    Thanks for any assistance.
    Jodi Dibble, CPC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Medicare vs commercial
    For Medicare, services must be face-to-face with PATIENT .... i.e. at the patient's bedside.

    For commercial carriers, and some MedicAID carriers, inpatient floor time is considered face-to-face. So if the family conference is held on the unit, in a conference room, that counts as face-to-face.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    Daytona Beach, FL
    Posts
    742
    Default
    Tessa - thank you again! You are always helpful.
    Jodi Dibble, CPC

  4. #4
    Default
    Hi There,

    I too do billing & coding for a hospitalist group. I found some good examples of what is approved by Medicare as prolonged time in the Evaluation & Management Manual published April 2010 and the Primary Care Manual published November 2008. Good Luck,

  5. #5
    Location
    Daytona Beach, FL
    Posts
    742
    Default
    Thank you dcelauro for your help. I will look into those Manuals - are these Medicare Manuals you are referring to or published by someone else?
    Jodi Dibble, CPC

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