Otolaryngology Coding Alert

Question: A patient with complications from a bee sting presented to our office. Our allergist administered the appropriate medications for the reaction and stayed with the patient for two hours until he was stable. How should I code for this office visit? Can I report the medications separately?

Tennessee Subscriber

Answer: If you want to report the physician's administration of the medication, you could use an E/M code based on the nature of the presenting problem and the documentation, such as 99214 (Office or other outpatient visit for the E/M of an established patient ...). You would bill 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the IM injection due to the allergic reaction. Also, you can bill a J code, such as J0170 (Injection, adrenaline, epinephrine, up to 1 ml ampule).

And, you may assign codes +99354 (Prolonged physician 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 evaluation and management service]) and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged service]).

But before using these codes, you should know how to calculate your time - which might be harder than you think. CPT assigns each office or other outpatient E/M code (99201-99215) a typical time for completing the service. When you use the prolonged service codes, you must subtract the stated E/M time (25 minutes related to 99214) from the amount of time your physician treated the patient (two hours). The remaining time is only one hour and 35 minutes (95 minutes). So, you can use 99354 for the first 30-74 minutes beyond the first 25 minutes), and you can use 99355 for the last 21 minutes. The physician needs to spend a minimum of 15 minutes face to face with the patient for each additional 30 minutes (99355). So, assuming that your otolaryngologist's documentation meets the requirements for 99214, you should code the service with 99214, 99354, 99355, 96372, andJ1070 times the appropriate number of units.

NOTE: In order to code and bill 99354 and 99355, the physician must be with the patient face to face for the entire time. If the patient is kept in the office in case of a bad reaction and the physician wants to be nearby but he continues to see other patients, you cannot charge the prolonged services codes. There are codes for prolonged services not requiring face to face time: 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and 99359 (Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service). However, few payers recognize these code nor pay for them.