Neurology & Pain Management Coding Alert

Question: I recently received a denial from Medicare for 99356 billed on the same day as 99255 (initial inpatient consultation, highest level, physicians typically spend 110 minutes at the bedside and on the patients hospital floor or unit). The patient was seen as a consult in the hospital (99255) and spent several hours back and forth to the intensive care unit while the physician helped to stabilize (99356) her.

New York Subscriber

Answer: As per the introductory text in CPT 2001 for prolonged services, these codes are to be reported in addition to other physician services, including an E/M at any level. Time is a very important factor to consider when billing prolonged service codes in addition to an E/M service. If your documentation reflects that the total time spent with the patient supports the level five E/M (typically 110 minutes) plus one hour of prolonged service, you should appeal the denial using the documentation to support your claim. Also, keep in mind that 99356 (prolonged physician service in the inpatient setting, requiring direct (face-to-face) patient contact beyond the usual service [eg, prolonged care of an acutely ill patient, first hour]) is only for the first hour of prolonged service and 99357 should be used for each additional 30 minutes spent.

Note: For more on billing for prolonged services, see the article in the May 2001 issue of Neurology Coding Alert.


Answers for Reader Questions was provided by Laureen Jandroep, OTR, CPC, CCS-P, owner of A+ Medical Management and Education, a coding and reimbursement consulting firm and a national CPC training curriculum site in Egg Harbor City, N.J., Terry Fletcher, CPC, CCS-P, a healthcare coding consultant in Dana Point, Calif., and Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.