# Prolong Service in ER.



## Mindy Davis (Jan 7, 2010)

I am new to ER billing and was wondering if we can use Prolong CPT codes along with our E/M codes if a physician or Extender spends a great deal of time with a pt. I know we can use critical care time if the pt is critical but in these cases the pt is not.


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## mitchellde (Jan 7, 2010)

no you cannot use prolonged time codes wth ER E&M codes since there is no time component to those codes


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## roneal (Jan 7, 2010)

Since the E/M codes for ER are not time based, you are not able to use prolonged services. The CPT states "The use of the time based add-on codes requires that the primary evaluation and management service have a typical or spee published in the CPT codebook."

Hope this helps.

Robyn O'Neal CPC,CEMC
Denver, CO


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## Mindy Davis (Jan 7, 2010)

*Thanks*

I went to Seminar Tuesday and the lady speaking said that the Prolong Service codes had been reworded and that we could now use them. I just wanted to double check before I told my docs.


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## mitchellde (Jan 7, 2010)

Sorry she is mistaken, the 99358 and 99359 were reworded and 99358 is no longer add on , but those are prolonged non face to face.


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## Mindy Davis (Jan 8, 2010)

So would that mean that we can bill for them instead of ER E/M? I know ER E/M codes are not based on time like other E/M codes. I just want to make sure that I understand it correctly.


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## eadun2000 (Jan 8, 2010)

You cannot bill them... you can ONLY bill the 99281-99285 range unless cc was performed and documented.


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## jeanae1005 (Jan 9, 2010)

From my experience, we CAN bill out the 99354-99359 WITH the E/M.  According to AMA CPT, it clearly states: "This service is reported in addition to other physician services, including evaluation and management services at any level."  I have billed and been paid for these services along with the ED E/M.


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## mitchellde (Jan 9, 2010)

If you look at the 99354 you will see it is restricted to only certain codes.  You cannot add prolonged time to any code that does not have a timed component and that includes Er codes.


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## FTessaBartels (Jan 10, 2010)

*No prolonged service with ER*

I agree with Debra. Face-to-face prolonged service can ONLY be added when the basic E/M service has a time component.  ER services do not have any "typical time" associated with them, so you cannot use the face-to-face prolonged service codes. 

As an alternative, however ... if the patient is critically ill and the care provided qualifies as critical care, you could use those codes (99291-99292) instead of the ER service codes. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## jimbo1231 (Jan 11, 2010)

*Interesting Discussion*

When the Prolonged Services came out in the 90s it seemed to me that they made perfect sense for ED scenarios like Asthma treatment or Kidney Stone etc with lengthy time in the ED but not neccesarily CC. But as has been stated they can't be used since ED visits have no time component. However office visits are OK since they have the optional time component if counseling/coordination are greater than 50% of the vsit. It really seems that CPT got Emergency Medicine on a technicality since those codes seemed to apply to a lengthy ED non CC visit. I was surprised there wasn't more lobbying by ACEP about this.
Another option for a lengthy stay in the ED that is not CC are the Observation Codes. However there are a number of requirements to use them and they are not add on to the ED Visit code.

Jim


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## mitchellde (Jan 12, 2010)

jimbo1231 said:


> When the Prolonged Services came out in the 90s it seemed to me that they made perfect sense for ED scenarios like Asthma treatment or Kidney Stone etc with lengthy time in the ED but not neccesarily CC. But as has been stated they can't be used since ED visits have no time component. However office visits are OK since they have the optional time component if counseling/coordination are greater than 50% of the vsit. It really seems that CPT got Emergency Medicine on a technicality since those codes seemed to apply to a lengthy ED non CC visit. I was surprised there wasn't more lobbying by ACEP about this.
> Another option for a lengthy stay in the ED that is not CC are the Observation Codes. However there are a number of requirements to use them and they are not add on to the ED Visit code.
> 
> Jim


For observation to be an option at all the physician must write an order to admit to observation otherwise Er codes are what you have and maybe critical care.


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