Recoup $105 Extra Per Visit for Extended E/M Services

Your physician's time isn't free -- use prolonged service codes for extra services

Big mistake: Coders sometimes choose not to bill prolonged services because they believe carriers won't reimburse those codes. Even though not all carriers will pay, you still may be missing out on at least $105 per visit if you're not reporting prolonged services.
 
Endocrinologists often report extended times of service for inpatient and office visits because of time spent counseling and coordinating complicated treatments. You can bill for extended services using prolonged service codes (99354-99359) if the total reported time exceeds the typical time of the appropriate E/M code by at least 30 minutes. Prolonged service codes are used to report the total amount of time the physician spent with a patient on a given date of service, even if the time spent on that day is not continuous.
3 Guidelines Show You How
You have several choices when reporting prolonged services. There are separate prolonged service codes for direct face-to-face outpatient services (99354, 99355), direct face-to-face inpatient services (99356, 99357), and for prolonged physician services without direct patient contact (99358-99359). Use these codes correctly by paying attention to the following key requirements:

1. First you must select an appropriate E/M code based on all components of the visit (history, exam, and medical decision-making). Use prolonged service codes when the reported time for services provided is "over and above the particular code" you're billing, says Anita Carr, CPC, business office manager and assistant practice manager of Endocrine and Diabetes Associates in Louisville, Ky.

For example: A diabetic patient presents for a routine checkup and the endocrinologist provides all the documentation for a level-three, established patient office visit, including 15 minutes face-to-face time. However, when the patient's routine lab tests reveal low blood sugar, the physician decides the patient should stay in the office, drink some juice, and have his blood sugar checked again. The physician then documents an additional 35 minutes spent discussing the new lab results, the patient's management of his blood sugar levels, and several lifestyle factors that affect the patient's ability to effectively manage his diabetes. You use 99213 (Office or other outpatient visit for the evaluation and management of an established patient) for the basic E/M service and +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour) for the extended service time. You'll get paid about $105 for 99354.

2. Clock each visit and calculate the total time of physician services. To paint a clear picture of the total extended services, all parties involved in patient service -- physicians, nurses, and even lab technicians, if applicable -- should document the start [...]

- Published on 2004-03-12