Otolaryngology Coding Alert

Don’t forget these other prolonged service options.

As you adjust to the newest code changes for 2016, don’t forget about two important additions to your E/M choices. These new codes can help you capture work your clinical staff performs after your physician sees the patient for an E/M service – leading to additional reimbursement you might not have been able to capture in the past.

The two codes are:

• 99415 – Prolonged clinical staff service [the service beyond the typical service time] during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
• 99416 – …each additional 30 minutes (List separately in addition to code for prolonged services).

How to use them: It’s not unusual for your staff to provide care that goes beyond the time represented by the best-fitting E/M code. For example, a staff member other than the physician might spend additional time to help educate a patient about a new medication, therapy, or options for care. Codes 99415 and 99416 could be appropriate choices in those situations.  One thing to keep in mind is that the 50% of the time rule does not apply to 99415. At least 45 minutes beyond the reference time for the base code needs to be spent and documented before you can start using 99415.