Gastroenterology Coding Alert

Question: Our office manager said that time spent on E/M services, whether face-to-face or without the patient, has to be continuous in order to qualify for a prolonged service code. However, I was unable to find any proof of this rule in CPT^®. Can you advise?

Codify Subscriber

Answer: CPT^® guidelines for all the prolonged services codes (+99354-+99359) state that they are used to report the total duration of face-to-face or non-face-to-face time spent by a physician or other qualified healthcare professional on a given date "even if the time spent by the physician or other qualified health care professional on that date is not continuous."

This is especially important to keep in mind when reporting 99358/+99359, the prolonged service codes without direct patient contact, since you can report prolonged services such as these on a different date providing the services meet the CPT^® guideline of relating "to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management." CPT^® guidelines explicitly state, "This prolonged service may be reported on a different date than the primary service to which it is related."

At present, the service can't be reported for time spent over a series of days. Depending on the circumstances, in some cases, chronic care management code 99490 (Chronic care management services, at least 20 minutes of clinical staff time) might apply for staff (or physician time) of more than 20 minutes in a calendar month spent providing care management.