General Surgery Coding Alert

Question: I’m very confused by the change to prolonged service coding for 2023. Could you please simplify and clarify how to use the new codes and rules?

Michigan Subscriber

Answer: The situation is confusing with different sets of codes and rules for Medicare and private payers.

Key: For all payers, you add a prolonged service code when you’re reporting the evaluation and management (E/M) service based on time, and the provider has reached a specific time threshold. The difference is that CMS prolonged service codes kick in once the procedure goes 15 minutes beyond the maximum time mentioned in the code. Use the following table to see when and which prolonged service code you should use:

Note: Per the CY 2023 Medicare Physician Fee Schedule (MPFS) final rule, Medicare is still not recognizing consultation codes, which is why you won’t be able to use a prolonged service G code in addition to 99245 or 99255.