Neurosurgery Coding Alert

Question: We have a new neurosurgeon who sees complex pediatric cases, and his E/M visits usually last much longer than an average visit due to his extensive discussions with the parents. Can you explain how we can use prolonged service codes in this scenario?

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Answer: To report prolonged services in addition to an E/M code, you will need to count the time your neurosurgeon spends face-to-face with the patient. If the doctor doesn't have documentation of the time spent in his records, you cannot report these codes.

If the doctor does document the time, you'll look to prolonged service codes +99354 (Prolonged evaluation and management or psychotherapy service[s] [beyond the typical service time of the primary procedure] in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient evaluation and management or psychotherapy service]) and +99355 (...each additional 30 minutes [List separately in addition to code for prolonged service]).

Mark the minimum of 30 minutes:  Your neurosurgeon must spend at least 30 minutes longer than the E/M time you would otherwise be reporting. For example, you may read that a patient visit qualified for CPT^® code 99214, which has a typical time assigned of 25 minutes. In this case, your provider needs to spend a minimum of 55 minutes to begin billing prolonged service codes.

Prolonged services of less than 30 minutes are not separately reportable, and should instead be part of the E/M code that you are otherwise reporting for the encounter. Use the following guide to determine when you can report the add-on prolonged service codes:

• For 30 to 74 minutes: You can report +99354 when the extended E/M service lasts between 30-74 minutes longer than the typical time of the E/M code you are otherwise reporting.
• For 75 to 104 minutes: You'll report the add-on code +99355 in addition to +99354 when the session lasts between 75-104 minutes.
• Beyond 104 minutes: For every 30 minutes of extended duration beyond 104 minutes, you report an additional unit of +99355, as well as one unit of +99354.

Note: Keep complete documentation of the time your physician spent with the patient for E/M service, as well as what he discussed with the patient and/or his family.