Pediatrics Corner

Complicated endocrinology visits deserve full reimbursement

Prolonged service codes can be very useful to collect payment for the extended services that pediatric endocrinologists often report. "When you are dealing with children, you have to do a lot of explanation for the parents," says Anthony Azzi, MD, an endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C. And that's in addition to the lab work, hormone measure-ments, extensive exam and family history required to diagnose many cases.
 
Example: A 15-year-old girl is referred to your endocrinologist by her primary-care physician for an evaluation of her short stature (783.43) and delayed puberty (259.0). The endocrinologist examines the patient and decides to order a growth hormone stimulation test. All the documentation the physician provides for the visit points to 99244 (Office consultation for a new or established patient), except for the fact that the visit lasted for 98 minutes. Only 60 minutes are included in code 99244. What's a coder to do?

For this type of visit, the endocrinologist would have to do a very time-consuming history that involves detailed questions about family history as well as the patient's personal history, Azzi says. These detailed questions, combined with various concerns of the patient and family that will need to be addressed, can easily cause a visit to go over and above the normal time allotment for a particular E/M code. In this case, therefore, you would report 99244 and then report +99354 (Prolonged physician service in the outpatient setting requiring direct patient contact) to account for the 38 extra minutes.

Juvenile diabetes: Prolonged service codes may also be useful to account for extra time involved with the initial visit of a child who has just been diagnosed with diabetes. A diabetic child's first visit to the endocrinologist will often entail a long exam and discussion about the prognosis and plan of care, Azzi says. Depending on the documentation, you may be able to bill for prolonged services. Don't confuse this with billing for diabetes self-management training, which comes at a later stage and usually involves a nurse who provides counseling on the day-to-day management of diabetes.

- Published on 2004-03-12