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General Surgery Coding Alert

Reader Question:

Prolonged Services

Published on Sat Sep 01, 2001

Question: The surgeon sees a new patient with carotid stenosis in the office for a consultation. He orders an MRA but it returns inconclusive. When the patient visits again for the results, the surgeon orders a carotid arteriogram. The surgeon performs a history and physical on the patient a few days before the arteriogram is obtained. He then admits the patient to same-day surgery and must be available in case the radiologist has problems. He reviews the arteriogram with the radiologist, both while the patient is still on the table and again later when all the films are out. He tells the patient what was found and what needs to be done. He must also see the patient before discharge. How should this be coded?

Vermont Subscriber
 
 
Answer: As long as the encounter is well documented, it should be billed as an established-patient visit (99212-99215). The information provided indicates that the test was prescheduled, and therefore an admission is not billable and any E/M performed by the surgeon (such as a preoperative evaluation mandated by the hospital) prior to the arteriogram should not be separately billed unless it is for another, separately identifiable problem.
 
Because the surgeon did not perform the arteriogram, any information provided to the patient once the test is over constitutes a visit that may be paid separately using 99212-99215, as appropriate. The place of service should be listed as outpatient hospital.
 
Because the surgeons postservice visit likely consists mostly of counseling and/or coordination of care, time determines the correct codes. If the face-to-face services provided by the surgeon exceed the time parameters in the established-patient codes, the additional time may be billed using prolonged-services code 99354 (... first hour) and, if necessary, add-on code 99355 (... each additional 30 minutes), says Marcella Bucknam, CPC, billing and compliance coordinator at the University of Nebraska Medical Centers department of surgery in Omaha. The time the surgeon spends reviewing test results while the patient is on the table or talking to the patient, for example, can be counted toward prolonged services, as long as 30 minutes or more is documented (for 99354).  Services that are not face-to-face cannot be included in the time billed under prolonged services but may contribute to the established-patient visit.
 
Note: These recommendations are predicated on CMS/HCFA guidelines, which some private carriers may not follow. If a private payer does permit separate billing for E/M services performed before the prolonged service is performed, such permission should be obtained in writing.

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