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prolonged patient care or not?

  1. #1
    Exclamation prolonged patient care or not?
    Medical Coding Books
    We have a scenerio in which our hospitalists are seeing a patient during the day and then later that day they are having "family" discussions at length with the patients family.. they are wanting to bill for prolonged care on the patient. We can't seem to find anything that would point us in the direction that it's okay to bill for the prolonges service as non face-to-face, or anything that says no we can't do this. Looking for any help with this as we are at a loss and want to make sure we are correct in our billing practices.

    Thanks in advance for the help,
    ~Kimberly Maher, CPC

  2. #2
    Default reference
    http://www.cms.gov/manuals/downloads/clm104c12.pdf

    Are these patients being classified as critical care? section 30.6.12 E 4 is a good resouce for such patients.

    generally speaking prolonged services, as they relate to interaction with the patient and/or family members, or individuals making decisions on behalf of a patient are face-to-face. An exception in 30.6.12 E 4 d is noted.

    30.6.15.1 section g addresses inpatient codes, non-critical. However, this section requires face-to-face time.

    Also, the threshold of medical necessity must be met and documented. The reference above includes guidelines for medical necessity as related to prolonged service codes.

  3. #3
    Default
    Thanks for your help.. we will look at these resources.
    ~Kimberly Maher, CPC

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