Question: We bill based on time pretty frequently, particularly when we see pediatric patients who have complex situations or require surgery. Their parents have a lot of questions and our gastroenterologist is really good about documenting time in the records. We have never used a prolonged service code because the different types are intimidating. What’s the difference between them? Codify Subscriber Answer: E/M services that last longer than usual often means employing a prolonged services add-on code to describe the full extent of the service. But before you open up your CPT® code book, you need to make sure you know who provided the service and what they did. When you are coding for prolonged services in an office/outpatient setting, you’ll choose from the following codes: The difference between these two sets of codes for prolonged services would be who provided the service. Codes +99354 and +99355 are for prolonged services by a physician or other qualified health care provider — such as a nurse practitioner or physician assistant. Codes +99415-/+99416 are for clinical staff — such as a registered nurse [RN] or a licensed practical nurse [LPN]. One other difference is that +99354/+99355 include both prolonged E/M and psychotherapy, whereas +99415/+99416 only reference E/M. You must report +99354 and +99355 for office/outpatient E/Ms that have a time component, and the typical time of the E/M service code billed must be exceeded by 30 minutes or more — the “first hour” descriptor term means the threshold to report the service is 50 percent or more of this time. Also: The physician or advanced practice provider must be present to provide direct supervision of the clinical staff during +99415/+99416 encounters. Also remember that +99354, +99355, +99415, and +99416 all require direct patient contact. For prolonged services that occur before or after direct patient care, you’d use 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and +99359 (… each additional 30 minutes [List separately in addition to code for prolonged service]). An example would be prolonged review of outside medical records, imaging, etc., This can be reported for a different date than the E/M service it supports, but cannot be reported to sum up increments of time spent on more than one date.