Quick Quiz: Test Your Prolonged Service Skills

You're fairly clear on coding those in-office allergy crises that crop up from time to time, but you'd like a little practice, right? Try coding the following case studies and then review the responses offered by our experts to test your prolonged services coding acumen.
Case #1: A new female patient presents with allergies. After performing an evaluation, the physician tests for allergies using skin tests with allergenic extracts and a delayed reaction. The patient goes to the waiting room for 30 minutes to determine if she has an allergic reaction to the extracts. Fifteen minutes after the injection, the patient complains of tightness in her throat. Her face is flushed. She begins to cough and wheeze and becomes short of breath.
 
The allergist takes her into the treatment room and evaluates her condition. The physician gives her another injection to counteract the reaction and periodically evaluates the patient's response to the medication. After several evaluations, the doctor determines that the patient is stable, and she is allowed to go home. The allergist spent 30 minutes evaluating and treating the patient's response.
Coding #1: Use 99203 for the new patient office visit. For a level-three office visit, the physician usually takes a detailed history and exam, and the medical decision-making is of low complexity. Report 99354 for the additional 30 minutes spent in prolonged service. You should also report 95028 (Intracutaneous [intradermal] tests with allergenic extracts, delayed type reaction, including reading, specify number of tests) for the allergy testing and the appropriate code(s) for the type of injection given to counteract the reaction, such as J1200 (Injection diphenhydramine HCl, up to 50 mg) for a 25-mg shot of diphenhydramine hydrochloride. Link 995.3 (Allergy, unspecified) to the E/M codes.
Case #2: An established male patient periodically has an acute asthmatic attack. The allergist treats him in the office. When the patient presents with an acute attack, the doctor performs an E/M service based on the patient's presenting symptoms only. Because the allergist knows the patient well, he or she does not need to perform the highest level of established office visit to treat the acute asthma attack.
 
To treat the asthmatic attack, the allergist and office staff initiate therapy with vasodilator drugs and bronchodilators via an inhaler. The physician evaluates the patient's breath sounds at various intervals to determine the treatment effectiveness. An hour and a half later, once the acute attack is over and the patient is stable, he is allowed to leave the office without going to the emergency department. Before the patient leaves, the doctor counsels him briefly about his condition and the effects of the medication he used to treat the attack.
Coding [...]

- Published on 2003-09-15