Ob-Gyn Coding Alert

Question: I know the E/M codes for observation services changed, but I heard the prolonged services did too. Is that true?

Virginia Subscriber

Answer: Yes. CPT® 2012 E/M code revisions clarify timeframes and providers for both observation services and prolonged care.

Prolonged service: Codes +99354-+99359 delete "physician" and substitute "direct patient contact" for "face-to-face" requirements from the descriptors, which opens the door for other qualified health care professionals who have billing privileges in your practice to submit the codes when appropriate. For example, the new descriptor for +99354 will read: Prolonged service 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 E/M service). Direct patient contact still means a "face-to-face" service has been provided but also incorporates unit/floor time when appropriate.

Observation times: Similarly, effective Jan. 1, 2012, each code for initial observation care (99218-99220) specifies the amount of time an ob-gyn typically spends at the patient's bedside or on the patient's hospital floor. Code 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components ...) represents 30 minutes, code 99219 represents 50 minutes, and 99220 represents 70 minutes.