Profit From Prudent Use of Prolonged Services
Published on Thu Mar 01, 2001
Cardiologists who spend extended time counseling a patient or patients family may benefit financially from appropriate use of prolonged services codes. Many practices are unfamiliar with these evaluation and management (E/M) services, however, and often cardiologists dont document their time adequately which is the critical compliance guideline for billing these services and is essential to successful reimbursement.
CPT divides prolonged services into two subcategories: direct, or face-to-face contact, and without direct contact. For reimbursement, only the face-to-face codes are significant, as most carriers wont pay for nondirect prolonged services.
The four face-to-face codes are further categorized as inpatient or outpatient, as follows:
99354 prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g, prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service];
99355 ... each additional 30 minutes [list separately in addition to code for prolonged physician service];
99356 prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient]; first hour [list separately in addition to code for inpatient evaluation and management service]; and
99357 ... each additional 30 minutes [list separately in addition to code for prolonged physician service].
Document All Time Spent With the Patient
Prolonged services, along with critical care and care plan oversight, are one of three E/M code categories that are entirely time-based. Therefore the regular E/M categories history, exam and medical decision-making do not apply when billing for prolonged services. Instead, the amount of time spent face-to-face with the patient determines which code to bill.
Simply stating that the cardiologist spent extra time with a patient does not justify prolonged services. Rather, precise documentation is necessary, says Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist in North Augusta, S.C.
To charge for each additional half-hour of prolonged services, at least 15 minutes of the additional 30 minutes claimed must be documented. With any time-based code, whether critical care or prolonged services, when 30 minutes of the first hour [30-74 minutes HCFA time] is documented, youve met the documentation requirements for the first hour, Callaway explains. The same applies for the next 30 minutes, she says. If 75 minutes of face-to-face contact are documented, the cardiologist can charge for another half-hour.
Time should be documented in minutes, and noting the start and stop times although not required is also a good idea, Callaway adds.
Dont Use Prolonged Services Codes On Their Own
Prolonged services [...]
