Cardiology Coding Alert

Question: Could you explain the use of the prolonged physician services (99354-99357)? Sometimes my doctor spends several hours with a patient in the ICU/CCU, back and forth to the hospital for patient care. The time is not always consecutive time, therefore I cannot use the ICU code, so could I use the prolonged codes? If so, how could I bill; would I put it with a daily visit or could I put it on the same day as a consult history and physical (H&P) and do I need a modifier?

Arizona Subscriber

Answer: When billing critical care services, the time spent with the patient does not have to be continuous, says Wanda Oplinger, CPC, coding consultant for Cardiology Consultants, Ltd. in Belleville, Ill. Critical care codes 99291 and 99292 are used to report the total duration of time spent by the physician providing care to the patient. Code 99291 is billed for the first 30-74 minutes, and 99292 is billed for each additional 30 minutes.
I would caution you to make sure the physicians documentation supports the use of the critical care codes, Oplinger says. Services provided to a patient in the critical care unit but who are not critically ill should be billed with other evaluation and management (E/M) codes that support the appropriate level of service. The CPT manual gives detailed instruction for billing critical care services, she adds.
Prolonged service codes are used when a physician provides care that is beyond the usual service in either an inpatient or outpatient setting. These codes are used in addition to the E/M code. Prolonged service codes designated for direct (face-to-face) patient contact are 99356 (inpatient setting) for the first hour and 99357 for each additional 30 minutes. Both critical care codes and prolonged service codes (direct) require the physicians full attention to the patient. Services cannot be provided to any other patient during the same period of time. Cardiologists should check with local carriers concerning coverage for the prolonged services.