Neurology & Pain Management Coding Alert

Question: Medicare denies our claims for prolonged inpatient hospital services. We report 99232 and 99354. What else should we include with the claim?

West Virginia Subscriber

Answer: You should approach your coding from three perspectives in this case: hospital consult, prolonged service, and subsequent hospital visits.

Begin with selecting the appropriate consult code from 99251-99255 (Inpatient consultation for a new or established patient ...).

Next, report prolonged service in the hospital with +99356 (Prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring for high-risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient]; first hour [list separately in addition to code for inpatient evaluation and management service]). If your physician's care goes beyond one hour, also report +99357 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]).

Last, report your physician's follow-up care with the most appropriate choice from 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient -). You-ll submit this code for additional days your physician cares for the patient, but not on the same day as the initial consult and prolonged service.