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Thread: Prolonged Services/Observation status

  1. #1

    Default Prolonged Services/Observation status

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    It is my understanding that we cannot bill for prolonged servies wihen the patient has been admitted to observation. Can someone clarify this.

  2. #2
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    There are only two types of codes for Prolonged Services - outpatient and inpatient. Observation according to Medicare is an outpatient (http://www.medicare.gov/publications/pubs/pdf/11435.pdf). However, there are no times associated with observation so how could you apply Prolonged Services when it is a time based add-on code?

  3. #3


    Prolonged services in addition to hospital observation (CPT 99217-99220), observation or inpatient care services (CPT 99234-99236), critical care services (CPT 99291-99296), emergency department services (CPT 99281-99285), intesive (non-critical) low birth weight services (CPT 99477-99480) are not separately reimbursed. These types of services often involve multiple encounters over an extended period of time, continuous monitoring, and periodic assessments in which time is not a factor in determining level of service provided.


    American Medical Association. Current Procedural Terminology: CPT Professional Edition.

    Centers for Medicare and Medicaid Services (CMS).

    Ingenix. Healthcare Common Procedure Coding System (HCPCS) Level II Book
    Last edited by TonyaMichelle; 12-14-2011 at 07:46 AM.

  4. #4
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    I beg to differ with the above:

    +99356 - Prolonged physician service in the inpatient setting, requiring unit/floor tune beyond the ususal service; etc.

    This clearly states that it is possible but it is for inpatient which eliminates observation, ER, Intensive Care, etc.

    Inpatient codes do have average times and hence Prolonged Services would apply for coding. Now, whether insurance carriers recognize them and pay them is something different but since it is allowed, I recommend to my clients that they bill them so the insurance company at least knows the service was provided.

    Reference: CPT Professional Edition

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