Neurology & Pain Management Coding Alert

Question: If my neurologist spends a prolonged amount of time with the patient during an office visit and documents this, can we charge for this additional time? If so, how would we bill this?

Arizona Subscriber

Answer: It depends on what your physician spent time doing. What sort of visit is this? To use the prolonged services codes " +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient evaluation and management service]) and

+99355 (... each additional 30 minutes [List separately in addition to code for prolonged physician service]) -- you need to:

• Bill an E/M code that has a time component (such as 99201-99215, Office or other outpatient visit ...)

• Have documentation for a prolonged service that is more than 30 minutes beyond the typical time listed for the code you billed

• Have the medical need clearly stated for the prolonged service.