# Prolonged physician services 99356



## Gainingknowledgedaily (Apr 1, 2011)

My brain is not working so well or maybe I am just doubting myself. Can anyone tell me why this does not look correct to me?

This is a subsequent visit, inpatient hospital. 

He documented 
Floor Time (minutes): 70 
FacetoFace time (minutes): 45 minutes
Total Time (minutes): 70 minutes
plus the rest of note, which had a comprehensive exam and MDM of HIGH

Provider documented this to be 99233+99356
The coder previous to me documented 99232+99356
However, I would think it would be 99233+99365

I think this because his E/M level is high and he documented 45 minutes face to face. Is my interpretation correct?


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## mitchellde (Apr 1, 2011)

OK so if he had floor time of 70 minutes plus 45 minutes face to face with the patient and assuming there is documentation of the floor time and that it was relevant to this patient, then you have a total of 115 minutes.  If the documentation does support the comprehensive exam and high complexity then you do have a 99233, which is 35 minutes so subtract the visit level time from total time and you have 80 additional minutes for prolonged time.. 30 to 74 minutes is 99356, 75 to 104 minutes is 99356 and 99357 so I would bill
99233
99356
99357
assuming the documentation supports.
I am not sure why you wrote 99365 as that is not a code unless you meant 99356.  
If total time, face to face plus floor time was 70 minutes then you have 35 minutes for the prolonged so it would be
99233
99356
again assuming the documentation supports.


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## Gainingknowledgedaily (Apr 1, 2011)

Thank you so much for the reply. Sincerely appreciate it.

Total time was 70 minutes, so if I understand you correctly.

So he did meet a level 3, subsequent visit, which is 35 minutes. So I would then
TT 70 minutes
-35 minutes (99233)
35 minutes

So then I would bill 99233, 99356. 

I think I got it, my confusion was if I would count that time that was not FACE to FACE, the other 35 minutes, but this makes more sense.


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## mitchellde (Apr 1, 2011)

99356 includes documented floor time as well as face to face time.  but the floor time must be documeted as to what it was for such as speaking with floor nurse regarding patient or revieing relevant information at the nursing station, and it must be clear that this patient was the only one being discussed or researched during this time.. To document floor time of x minutes is not sufficient.  I was confused because your note says floor time 70 min and face to face 45 and then total time 70.. it does not add up correctly.


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## Gainingknowledgedaily (Apr 1, 2011)

Okay, now I understand. He did document that. He wrote a paragraph about he spoke with patient and daughter about palliative care, the condition he had, etc. 

How would recommend the that the sentence should look like?

Would it not have been suffice to just complete the e/m, because that is a 99233 and then just state 35 minutes above E/M level were spent speaking to patient and daughter about xxxx,etc.


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## mitchellde (Apr 1, 2011)

total face to face time must be documented and then the floor time must be documented.  If the patient was present during the discussion with daughter then this is still face to face time, it is not floor time.  so there fore if total face to face time was 70 min the codes 99233 and 99356 are still correct.  but to just document the E&M and additional 53 minutes spent is not enough, we must know the total of face to face to include the E&M time.


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## az2tn@yahoo.com (Aug 7, 2013)

I know this thread is 2 yrs old but I'm dealing with a similiar situation if someone could help. We are billing 99226-subs obs by the admitting-typically 35 mins but no time is documented for this encounter at all. And then I have another note where the provider was called back to review and then discuss some MRI findings with the pt. It is documented seperately from the E/M. He documented"Extended time 50 mins.  Are you saying the physician has to have time documented on the E/M-99226 to be able to code for prolonged service?


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