Cardiology Coding Alert

Question: Can prolonged services be billed for a hospital discharge that took much longer than average?

Maine Subscriber
 
 
Answer: Inpatient prolonged services codes 99356 (prolonged physician service in the inpatient setting; first hour) and 99357 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) cannot be used, because the discharge code in question is 99239 (hospital discharge day management; more than 30 minutes) and has no base time.
 
For a service to be considered prolonged, the amount of time spent providing care must exceed a set amount of time by at least 30 minutes. For example, if the cardiologist spends 90 minutes admitting a patient, the examination, history and decision-making performed warrant code 99222, which has a base time of 50 minutes. If the cardiologist documents 30 minutes of face-to-face time, prolonged-services code 99356 can be billed.
 
Note: If more than half of the 90 minutes spent by the physician was for counseling or coordination of care, the level of the visit is determined by time. Therefore, the admission code would be upgraded to 99223, which requires 70 minutes total time, and prolonged services would not be billed.
 
Some E/M services, including hospital discharge, do not have a base code, without which there is nothing to prolong. Code 99239, furthermore, specifically states, more than 30 minutes [emphasis added]. Therefore, regardless of the amount of time spent, it is the only E/M code that should be billed.
 -- Reader Questions answered by Gay Boughton-Barnes, CPC, MPC, CCS-P, chief medical compliance officer for the University of Oklahoma Medical Center in Tulsa; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Martha Gerant, CPC, a practice coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan.; Linda Laghab, CPC, a practice coder with Foothill Cardiology and California Heart, a 26-physician practice with offices throughout the Los Angeles area; Sandy Rubio, RN, CPC, a cardiology coding and reimbursement specialist in Omaha, Neb.; Rebecca Sanzone, CPC, billing manager with Mid-Atlantic Cardiology, a 45-member cardiology practice in Baltimore; Nikki M. Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.