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Prolonged Service and Hospital Visit

  1. #1
    Prescott, AZ
    Default Prolonged Service and Hospital Visit
    Medical Coding Books
    Our physician documented in the hospital record that he was there from 810am - 845am to visit a patient. He wanted to code as 99233 and 99356. He also made note that he had a discussion with the patient's spouse.

    I understand that 30-74 minutes can be 99356, but when does the timing for this service start? Is it included in the total time, or start later, after the suggested CPT 2011 that 99233 is typically 35 minutes. Would the timing start at minute 36??

    This patient was seen at total of 35 minutes - if prolonged service starts at minute #1, then I can code 99233 and 99356. If it starts at minute 36, then I can't code 99356, only 99233. Right???

    If a patient was seen a total of 79 minutes, would this be correct?? Assuming all elements of 99233 have been met...
    810 am - 845 am = 35 minutes 99233
    846 am - 930 am = 44 minutes 99356

    This has been confusing to me for awhile and I'd like to get it coded correctly!! Thank you!!!
    Tracy, CPC
    Tracy L. Wood, CPC

  2. #2
    Columbia, MO
    to use prolonged time you take the total face to face time and subtract the visit time per the CPT book for the level of service documented. The time left over must be a minimum of 30 additional minutes before you can append prolonged time.
    for instance to code bothe a 99213 and a 99354 you must have a minimum of 45 minutes of face to face time documented. you take the 15 minutes assigned in the CPT book for the 99213 and subtract from 99354. So he has a total of 35 minutes documented with a 99233 documented which is you say is 35 minutes ( my book is not present) then when you subtract there is 0 minutes left for prolonged time so no you may not. You will need a minimum of 65 total minutes documented. Even though he spent additional floor time with family, he does not document that time so we can only use the 35 minutes documented.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Prescott, AZ
    Thank you!!! This helps a bunch!!!
    Tracy L. Wood, CPC

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