Ophthalmology and Optometry Coding Alert

Dont let the abundance of guidelines for the prolonged services codes deter you from reporting them they may be your only means of receiving additional reimbursement for the extra time your physician spends managing a patients narrow-angle glaucoma attack. When a patient with glaucoma presents during a narrow-angle (365.22) or angle-closure attack (365.20), pressure in the patients eye can build up rapidly as aqueous fluid blocks the trabecular meshwork. Even though glaucoma attacks are considered emergencies, they are often managed and treated in the ophthalmologists office. Managing these attacks in the office can greatly exceed the amount of time allotted for standard E/M services and to get paid for your ophthalmologists extended services, you may need to use the prolonged services codes. The prolonged services codes, 99354-99357, represent the face-to-face physician-patient time "that is beyond the usual service in either the inpatient or outpatient service," according to CPT, which is why these services are add-on codes, reported in addition to other E/M codes that include a reference to time, without which, there is no way to determine when a service can be classified as "prolonged."

Sherry Wilkerson, RHIT, CCS, CCS-P, director of coding and compliance for Esse Health in St. Louis, explains how they work. Lets say a physician sees an established patient who is having a narrow-angle attack. The physician provides an E/M service that measured by the key components of history, examination and medical decision-making qualifies as a level-four outpatient visit, 99214, which has a 25-minute physicianto- patient time allotment. But the ophthalmologist spends one hour (35 minutes more than the allotted 25 minutes) monitoring the attack. The ophthalmologist may report  99214 and +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-toface] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office and other outpatient evaluation and management service]) to account for the additional time he spent monitoring the attack, trying different medications, managing the patients pain, and determining whether the patient will have to have surgery if the topical and oral medications are ineffective. If the physician had spent less than 55 minutes total time with the patient, or fewer than 30 minutes more than the E/Ms allotted 25 minutes, the ophthalmologist would not have been able to use the prolonged services codes to account for that additional time. Getting reimbursed for your ophthalmologists time and navigating through the prolonged services guidelines can be a snap if you use the following answers to frequently asked questions about the following codes: 99354 +99355 each additional 30 minutes (list separately in addition to code [...]