# Prolonged Services - what codes he is spaking



## ahinman (Sep 19, 2012)

Hello,  Looking for some help on prolonged services codes.  I have a new ED director in our ED and he was speaking of using prolonges services codes for the ED.  The type of patient that would be falling into this criteria would be for example a patient that comes in drunk and is obseved for several hours until the alcohol level comes down and is then discharged.  The patient was never considered for observation however just kept long enough to be sober.  

      I am not sure what codes he is spaking of I have looked though my CPT book and can only find a few codes for prolonged service however it looks as though these do not pay for the ED patient type.  

     He does state the last facility he was working for was using something of this type however I have no idea what codes??  and if they should be used with the ED??  

     Does anybody do anything like this??

Thank you!


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## AB87 (Sep 19, 2012)

Those claims they bill are wrong because CPT states that Time is not included with the ED Codes. Its Based on the Prensenting Problems and its hard for ER Docs to get an exact amount of Time they spend. Read "Coding Tip" right under the ER Codes in your CPT Book.


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## lmbroomall (Sep 19, 2012)

I think she is referring to cpt 99354-99357 and 99358 and 99359 for prolonged services. I realize it is tough sometimes for er docs to document time but time is needed for critical care that is used in the er.  
I am not sure what codes your er doc would be talking about either since the above cpt codes are add ons and do not include the e/m cpts for er.


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## jimbo1231 (Sep 19, 2012)

*Prologed Services for the ED*

There are Prolonged Services rendered in the ED, but the Prolonged Service CPT codes are not for the ED Place of Service. The thinking behind it was that time is never a factor in determining ED Levels except Critical Care. In this case we are talking about say office or hospital visits where time can be used to determine the Level if more than 50% of the visit is counseling etc. That option doesn't exist in the 99281-5 series so adding on on a code with a potential time element to an ED code is phohibited by CPT/CMS. I know it doesn't make much sense but those are CPT Guidelines.
An option for patients who spend several hours in the ED could be Observation coding. These codes require documentation and Medicare requires at least 8  hours, but some "Prolonged Services" could legitimately be coded as Observation based on appropriate documentation.

Jim


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## jimbo1231 (Sep 19, 2012)

*Not considered for Observation?*

Just notoced you mentioned that. Actually the senario you described; intoxicated, maybe dehydrated, IV fluids etc often is coded as an Observation service. Remember to code for Observation Services on the physician side a separate staffed Unit is not required (it is on facility side). Proper documentation including an ADMIT to Observation Status, a plan of treatment and E&M documentation is required. Might be an opportunnity.

Jim


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## ahinman (Sep 20, 2012)

Jim,

Thank you so much for your help.   I have been coding ERs for many years and I was coming up with the same conclusion that you were that the prolonged service codes could not be used with the ER code set from CPT.  However, the question is being brought up to me and I needed some input from other ED professionals.

Again, Thank you!

Amy


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