Ob-Gyn Coding Alert

You should be charging for all the time you spend seeing a patient. Especially in those long initial visits, says Barbara J. Cobuzzi, MBA, CPC, a physician reimbursement specialist and president of Cash Flow Solutions, Inc., of Lakewood, NJ. Most of the time when ob/gyns see patients, the time spent face-to-face with the patient falls within a typical range for the level of service being provided. This typical or reference time is reflected in the CPT manual when you select which Evaluation and Management (E/M) code to use when billing for the office visit.

But often ob/gyns spend much more time with their patients than the typical time defined by the E/M code, Cobuzzi relates. For example, a patient who has been sexually assaulted will likely require a great deal of the ob/gyns time, not only for the physical examination but for helping the patient deal with the emotional issues surrounding the assault. Other situations that would likely require a lengthy office visit would be a teenage patient who became distraught after receiving a positive pregnancy test, or a diabetic patient who did not speak English and relied on her daughter to translate details about an imminent hysterectomy.

In each of these cases, coders can request that the practice be reimbursed for the additional time that the ob/gyn has spent in face-to-face contact with the patient. This request is coded using Prolonged Services codes (99354-99355). Prolonged services are one of the most misunderstood and under-utilized coding opportunities, asserts Cobuzzi. Heres how these codes are used.

Determine the Typical Amount of
Time Allotted

First, coders must select the appropriate E/M codes for the service, since Prolonged Services codes are always used as an adjunct to other service codes. In the office setting, these codes include Office Visit codes (99201-99205 for new patients and 99211-99215 for established patients). Each of these E/M codes contains a time element, as defined in the CPT manual. Cobuzzi says these are the reference times (i.e. the typical, average amounts of face-to-face time that the physician spends with patients and/or their family members when the office visits are associated with those codes.) These times are as follows:

New Patients Established Patients:

99201 10 minutes 99211 5 minutes
99202 20 minutes 99212 10 minutes
99203 30 minutes 99213 15 minutes
99204 45 minutes 99214 25 minutes
99205 60 minutes 99215 40 minutes

Note: The typical time allotted for the new patient visit is slightly more than that associated with the same level visit for an established patient. This difference reflects the additional time that it takes the physician to assess a patient with whom he is unfamiliar.

Calculate the Additional Time Spent

Once you have determined the proper E/M code, and the typical time associated with it, you can compare [...]