Oncology & Hematology Coding Alert

Question: Denials for prolonged services plague my office. Do you have any advice on how best to report codes 99354-99357?

Oregon Subscriber Answer: When you report prolonged services, your oncologist must document all of the time that he spends face-to-face with the patient. The primary reason for this is that these are time-based codes.

For instance, if you assign +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact ...; first hour [list separately in addition to code for office or other outpatient evaluation and management service]), the documentation should show that the "prolonged" service that your physician provided lasted an hour. In other words, without an actual minute value stated in the physician notes, prolonged service codes are not valid no matter how much time the physician actually spent.

Another tip: The time you count toward prolonged services need not be continuous, although it should occur on the same date of service. The oncologist may consult with a patient in the hospital, spend 30 minutes discussing his condition, leave to perform regular rounds, and return to the original patient for another 40 minutes of counseling. The time spent with the patient both before and after the physician made rounds can contribute toward prolonged services.

The documentation must also explain why the physician provided prolonged services, according to MCM instructions (section 15511.1). Simply noting that the physician spent an extra 42 minutes with the patient is not adequate.