Oncology & Hematology Coding Alert

When an oncology-related visit takes longer than normal, codes +99354-+99355 used to describe a prolonged visit with face-to-face physician-patient contact are appropriate as long as the circumstances and services that resulted in extra time spent can be proven. In contrast, these codes should not be used for an extended visit that includes routine services.

There has to be face-to-face contact with the patient where the disease is discussed, says Dianna Hofbeck, RN, CCM, HCFE, RN CCM, ACFE, president of North Shore Medical, a billing, coding, collection and healthcare consulting firm in Atlantic City, N.J. You have to document the exact amount of time and the reason behind it.

The codes can be used either to report added time as a result of unforeseen circumstances, such as the discovery of a new condition, or for additional visit time beyond what the physician normally spends with a patient, says Riise Cleland, president of Oplinc Oncology Services, an oncology coding consulting firm in Lawton, Okla. An example would be counseling before and after a chemotherapy visit.

You can use prolonged service codes under the following circumstances:

They may be added to any other physician service, including an E/M;

They should be used to report the total duration of face-to-face contact, even if the time is not continuous;

They may be used only once per date of service, even if the time spent with the physician was not continuous.

If the prolonged service was less than 30 minutes, then +99354 is not separately reportable and the service should be included with the E/M.

While +99355 is used to report time spent with the patient beyond the first hour, it must be between 15 and 30 minutes. If the time is less than 15 minutes, then +99355 should not be reported in addition to +99354. Subsequent uses of +99354, when prolonged service extends beyond 90 minutes, for example, should be used just as it would be for service beyond one hour. If it does not extend beyond one hour, 45 minutes, then +99355 can only be reported once. If time extends beyond one hour, 5 minutes, then +99935 can be reported twice.

Justifying Prolonged Service Codes

An office visit for a follow-up on chemotherapy treatment may take an average of one hour, including the examination and a problem-focused history. On occasion, this type of visit may run longer, perhaps 45 minutes to one hour longer. On the surface, this may seem like an appropriate time to assign +99354.

However, deciding whether to use +99354 or +99355 is not as objective as you would think. Rather than using time as the determining factor, you should consider the surrounding circumstances instead.

As long [...]