ED Coding and Reimbursement Alert

Answer: No you can never use prolonged services code +99417 (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)) — or any other prolonged services code — on ED E/M codes.

Why? Time is not part of the descriptor for ED E/M services; you can’t code for prolonged service time because there are no time frames for each ED E/M level. For example, look at the descriptor for 99283 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making).

Further, CPT^® explicitly forbids using time as a factor when coding E/Ms. In a Coding Tip in the introductory section for Emergency Department Services from CPT^® 2024, “Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.”