The prolonged service codes can be added to ANY E/M code. Code the level that is documented, and then add the extended time spent with the patient (must be at LEAST 30minutes direct face-to-face time over and above the time spent in the base E/M).
Two thoughts on your scenario ...
1) Was the patient critically ill, and was the care provided critical care? CPT 99291 CAN be used outside of a hospital (though it is extremely rare and you will definitely be asked to provide documentation to support this). Physician must document critical nature of patient's condition and the fact that s/he provided at least 30 minutes of direct face-to-face critical care time.
2) Since patient was sent to hospital ... was the physician the admitting physician? Did s/he see patient in hospital the same DOS? If so, then all services provided this same DOS are rolled into the Initial Hospital Visit level of service.
Hope that helps.
F Tessa Bartels, CPC, CEMC
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join