Prolonged Services Codes Are Alternative to Timed E/M Visits
Published on Sat Dec 01, 2001
The codes for prolonged services with direct patient contact (99354-99357) can be used to bill for E/M sessions that extend at least 30 minutes beyond the time limits established by CPT. An article in the July 2001 Gastroenterology Coding Alert, "Boost Level of Follow-Up E/M With Time as the Key Component," recommended that gastroenterologists use time as the key component when determining the level of a follow-up office visit when more than 50 percent of the session was spent in counseling and coordination of care. However, one reader, Barry Kisloff, MD, a gastroenterologist and director of Clinical Services and the Digestive Disorders Center at the University of Pittsburgh Medical Center, reports that his practice believes it is more appropriate to use the prolonged services codes to report E/M sessions when more than 30 minutes are spent in patient education and counseling.
"The gastroenterologist rendering largely counseling and/or education services during a patient encounter (in an office setting) may use the prolonged services codes in addition to the appropriate established office-visit code (99211-99215). The prolonged services codes seem clearly to be used for 'nonhands-on' services, which are so vital to the patient-physician relationship," Kisloff says.
More Compliance-Oriented
E/M codes are designed to work with hands-on medicine, or office visits where the focus is on the traditional components of history, examination and medical decision-making, Kisloff says. "You examine the patient, then go through the systems and ask if he or she has any allergies or is taking any new medications. All discretely hands-on," he explains. "What has happened is that a large part of what any gastroenterologist does now is not hands-on. Patients have questions about the long-term effects of their medication, the natural history of their illness, or they bring in a family member who has questions for the doctor."
While gastroenterologists may be reporting more high-level E/M codes based on time, payers often look critically at these visits, says Kisloff, who feels that the prolonged service codes may be more compliance-oriented than an E/M code based on time as the key component. "If the patient's spouse walks in the room to talk about the interferon being given to treat the patient's hepatitis, and the gastroenterologist bills that session as 99214 ( ... physicians typically spend 25 minutes face-to-face with the patient and/or family) the payer is going to scrutinize that because the history, exam and medical decision-making may not justify that level of service," Kisloff explains.
"You then move into the arena of prolonged service codes," he continues. "The CPT definition for the code says 'beyond the usual service,' which is what patient education is about."
The prolonged service codes requiring direct patient contact are as follows:
99354 prolonged [...]
